Predicting Waist Circumference From a Single Computed Tomography Image Using a Mobile App (Measure It): Development and Evaluation Study

Background

Despite the existing evidence that waist circumference (WC) provides independent and additive information to BMI when predicting morbidity and mortality, this measurement is not routinely obtained in clinical practice. Using computed tomography (CT) scan images, mobile health (mHealth) has the potential to make this abdominal obesity parameter easily available even in retrospective studies.

Objective

This study aimed to develop a mobile app as a tool for facilitating the measurement of WC based on a cross-sectional CT image.

Methods

The development process included three stages: determination of the principles of WC measurement from CT images, app prototype design, and validation. We performed a preliminary validity study in which we compared WC measurements obtained both by the conventional method using a tape measurement in a standing position and by the mobile app using the last abdominal CT slice not showing the iliac bone. Pearson correlation, student t tests, and Q-Q and Bland-Altman plots were used for statistical analysis. Moreover, to perform a diagnostic test evaluation, we also analyzed the accuracy of the app in detecting abdominal obesity.

Results

We developed a prototype of the app Measure It, which is capable of estimating WC from a single cross-sectional CT image. We used an estimation based on an ellipse formula adjusted to the gender of the patient. The validity study included 20 patients (10 men and 10 women). There was a good correlation between both measurements (Pearson R=0.906). The student t test showed no significant differences between the two measurements (P=.98). Both the Q-Q dispersion plot and Bland-Altman analysis graphs showed good overlap with some dispersion of extreme values. The diagnostic test evaluation showed an accuracy of 83% when using the mobile app to detect abdominal obesity.

Conclusions

This app is a simple and accessible mHealth tool to routinely measure WC as a valuable obesity indicator in clinical and research practice. A usability and validity evaluation among medical teams will be the next step before its use in clinical trials and multicentric studies.

McGrath® versus Macintosh laryngoscopes on hemodynamic response to intubation in elderly patients: a randomized clinical trial

Introduction

laryngoscopy and tracheal intubation induce catecholaminergic release. Our study aimed to evaluate the hemodynamic impact of orotracheal intubation by McGrath® compared to the Macintosh laryngoscope in the elderly.

Methods

we conducted a prospective randomized clinical trial that included elderly patients proposed for a scheduled surgery under general anesthesia with orotracheal intubation and divided into 2 groups: patients who were intubated using the McGrath® (group V) and patients who were intubated using the Macintosh direct laryngoscope (group M). Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial blood pressure (MAP), were recorded before induction of anesthesia (baseline), and at 1 min, 3 min, and 5 min after intubation. Our outcomes were the increase of SBP (∆ SBP), MAP (∆ MAP), and HR (∆ HR) between the two groups, during the 5 minutes following the start of the orotracheal intubation, intubation time and the incidence of its related complications.

Results

sixty patients were included and randomized into 2 groups of 30. The average age of our sample was 70±6 years with a sex ratio of 1.22. Most of the patients were operated on for orthopedic, urologic, or abdominal surgery. There were no statistically significant differences between the two groups in terms of demographic characteristics and the duration of anesthesia (p> 0.05). The intubation time was significantly increased in group M (p≤0.001). There was a significant difference in SBP, MAP, and HR values at 1 min after orotracheal intubation compared with the baseline values in Group V(P<0,05) and Group M (p < 0.05). There was a significant increase in the first minute after tracheal intubation in terms of SBP (151±42 vs 134.5±26 mmHg, p=0.012), MAP (114±4 vs 102±17 mmHg, p=0.015), DBP (89±32 vs 84±16 mmHg, p=0.01), and HR (99.5±10 vs 94.5±2 b/min, p=0.008) when group M was compared to group V. The ∆SBP was significantly different between group M (∆SBP = 36.2±23.5mmHg) and group V (∆SBP= 30.77±21.6mmHg) (p = 0.005). There were 4 ventricular arrhythmias in group M versus zero in group V (p <0.0001). The postoperative sore throat was significantly decreased in group M vs V (p=0.036).

Conclusion

the McGrath® videolaryngoscope decreased the hemodynamic fluctuations due to endotracheal intubation in elderly patients.

[The effect of intraperitoneal administration of dexamethasone on postoperative analgesia after laparoscopic cholecystectomy: a prospective randomized controlled double-blind study]

Introduction

the effect of intravenous corticosteroids on postoperative pain has been well demonstrated; however, few studies have focused on the efficacy of intraperitoneal corticosteroid use after laparoscopic surgery. The purpose of this study was to evaluate the effect of intraperitoneal administration of dexamethasone on postoperative analgesia after laparoscopic cholecystectomy.

Methods

we conducted a prospective, randomised, double-blind, controlled study, including patients scheduled for laparoscopic cholecystectomy and randomised into two groups: the group D (receiving 16 ml: 12 ml saline and 4 ml solution containing 16mg dexamethasone) and the group T (receiving 16 ml saline). The primary endpoint was: Visual Analogue Scale (VAS) for abdominal pain during the first 24 hours after surgery. The secondary endpoints were the incidence of shoulder pain, time to first request for analgesia, the consumption of morphine in the post-intervention surveillance room (PACU), the consumption of non-opioid analgesics and the incidence of nausea and vomiting during the first 24 hours after surgery as well as the presence of complications.

Results

sixty patients were included in the study and divided into two groups of 30. Demographic parameters, duration of surgical and anesthesia procedures, as well as intraoperative fentanyl consumption were comparable between the two groups. Abdominal pain VAS values (p≤0.001), the incidence of shoulder pain (p<0.001), opioid and analgesic consumption (p<0.001) and the incidence of nausea (p=0.002) and vomiting (p=0.012) during the first 24 hours after surgery were significantly lower in group D. No complications related to dexamethasone administration were noted.

Conclusion

intraperitoneal dexamethasone reduces postoperative pain after laparoscopic cholecystectomy.

Alexithymia In Multiple Sclerosis: Relationship With Depression

Introduction

Alexithymia, the lack of words to express emotions, is a common problem in multiple sclerosis (MS) patients.

Objectives

To investigate the prevalence of alexithymia in patients with MS and to evaluate the factors related to it, including depression.

Methods

We conducted a cross-sectional, descriptive and analytical study, which took place in the neurology department in Sfax (Tunisia). It involved MS outpatients in remission phase. Data collection was done using a form exploring sociodemographic, clinical and radiological characteristics. We used the Expanded Disability Status Scale (EDSS) to evaluate neurological impairments, the Toronto Alexithymia Scale (TAS-20) to assess alexithymia, and the Hospital Anxiety and Depression Scale (HADS) to assess depressive symptoms.

Results

Our study included 93 patients. They were married in 57% of cases. The total number of relapses ranged from 1 to 30, with a median of 5. The EDSS score ranged from 0 to 8. A temporal lesion on brain imaging was found in 29% of cases. MS patients had alexithymia in 58.1% of cases and depression in 26.9% of cases. Alexithymia was more frequent in unmarried patients (p = 0.028). Among clinical and radiological factors, the number of relapses was higher (p = 0.035), and temporal lesion was more frequent in alexithymic patients (p = 0.045). In this study, alexithymic patients were more depressed (p < 10^-3).

Conclusions

According to our results, depression and alexithymia were found to be significantly inter-related in MS. Future longitudinal studies might better clarify the nature of this relationship in MS patients.

Disclosure

No significant relationships.

Study of resilience in a population of tunisian residents and interns in medicine

Introduction

Resilience is the ability to bounce back or cope successfully with stress. Fostering resilience is a promising way to mitigate the negative effects of stressors and prevent burnout.

Objectives

Study the level of resilience among Tunisian medical interns and residents.

Methods

We conducted a cross-sectional descriptive study between March 1 and April 15, 2021. Medical interns and residents were invited to complete an online self-questionnaire. We used the Brief Resilience Scale (BRS) to assess the level of resilience.

Results

The total number of participants was 56 of which 28.6% were male. The average age was 26.76±2.52 years. Most of the students had studied at the Faculty of Medicine in Sfax, 58.9%. 64.3% of the participants were residents, 55.4% of them in a medical specialty. 75% of participants were working in a medical department. The average years of practice was 2.27±1.23. The number of working hours per week exceeding 40 hours was found in 60.7% of participants. The number of shifts per month exceeding 4 shifts was found in 67.9%. 46.4% of the participants wanted to change their profession and 44.6% regretted choosing medicine. The mean score by BRS was 2.79±0.48. The level of resilience was high in 42.9% of the participants and normal in the rest of the respondents.

Conclusions

The level of resilience was normal to high in Tunisian medical interns and residents. Assessing the presence of burnout and the coping strategies used could provide insight into the quality of work life.

Disclosure

No significant relationships.

Burden level among parents of children with epilepsy

Introduction

Family caregiving role of children with epilepsy involves managing the daily lives of these children with disabilities. This can lead to impaired physical and psychological health of the caregiver.

Objectives

To assess the level of burden among caregivers of children with epilepsy and to determine the factors associated with it.

Methods

It was a descriptive and analytical survey. It involved the caregivers of children with epilepsy who were admitted to the pediatric neurology department at the Hedi Chaker University Hospital in Sfax during the period from July to October 2020. We used the 12-item Zarit (ZBI-12), the State-Trait-Anxiety Inventory (STAI), and the “BECK” Depression Inventory (BDI-13) to assess caregiver burden, anxiety and depression respectively.

Results

Forty-four caregivers participated in the survey. Their average age was 36 years and their relationship with patient was mother in 93.2% of cases. Among 44 children with epilepsy, 56.8% were boys and 34.1% were schooled. They had psychiatric comorbidity in 15.9% of cases. According to the ZBI scale, the level of burden was high in 45.5% of cases. The total ZBI score was significantly higher among caregivers with primary school level (p=0.05) and those with somatic disease (p=0.004). It was not correlated with the presence of child’s dependence on the others (p=0.20). High levels of depression, anxiety-state, and anxiety-trait among caregivers were correlated with the level of burden (p 0.000; 0.000 and 0.001, respectively).

Conclusions

Being a caregiver of a child with epilepsy is a burdensome circumstance. Hence the importance of offering psychological assistance for these caregivers.

Disclosure

No significant relationships.

Emigration intentionality among Tunisian interns and residents in medicine

Introduction

Emigration is the act of leaving one’s country of nationality or habitual residence to settle in another nation. In Tunisia, this phenomenon is increasing in particular for doctors.

Objectives

Evaluating the intentionality of emigration among interns and medical residents in Tunisia while studying the factors related to it.

Methods

We conducted a cross-sectional, descriptive and analytical study of interns and medical residents who participated in our study through the social network ’Facebook’ by an anonymous self-questionnaire. The level of satisfaction with the different aspects of life were assessed by a 5-point Likert scale, from “not at all satisfied” to “very satisfied”.

Results

The total number of participants was 56 of which 64.3% were medical residents. More than 50% of the participants expressed dissatisfaction with the distribution of tasks and organization of work (66.1%), safety at work (53.6%), comfort (57.2%), time allocated to personal life (53.6%) and salary (69.6%). The political, health and educational situation in the country was considered unsatisfactory by the majority of participants (90% to 95%). Among our participants, 44.6% regretted having chosen the profession of medicine and 53.6% had plans to immigrate to work abroad. The intentionality of immigration was significantly higher among men (p=0.02), those with siblings abroad (p=0.047) and those without dependent relatives (p=0.040).

Conclusions

Young physicians are strongly looking for emigration. This decision could emanate from professional, personal and political factors. Further studies seem to be necessary to explain this emigration phenomenon.

Disclosure

No significant relationships.

job satisfaction and its impact on resilience: a cross-sectional study of Tunisian interns and residents in medicine

Introduction

Preventing burnout and promoting resilience are important to the well-being of health care professionals and the quality of patient care. Indeed, it’s a promising way to mitigate the negative effects of stressors and allow professional growth.

Objectives

study the association between job satisfaction and resilience in medical interns and residents.

Methods

As part of a descriptive and analytical cross-sectional study, interns and medical residents completed an online self-questionnaire using ’Google Forms’. It collected socio-demographic data and assessed the level of job satisfaction using a 5-point Likert-type scale for each item. The Brief Resilience Scale (BRS) was used to assess the level of resilience.

Results

The total number of participants was 56, of which 64.3% were medical residents.75% of the participants worked in a medical department and most had a number of shifts per month ≥4. The average years of practice was 2.27±1.23 years. Participants expressed dissatisfaction at work with salary (69.6%), task allocation and organization (66.1%), availability of resources (66.1%), comfort (57.1%), safety (53.6%) and supervision (50%). Referring to the BRS scale, higher resilience scores were objectified in male participants (p=0.002). The level of resilience decreased with the number of years of practice (p=0.039). Good satisfaction by management and recognition at work could enhance the level of resilience (p=0.029 and p=0.043 respectively).

Conclusions

The results of our study suggest that dissatisfaction with work-related aspects may influence the level of resilience. These results deserve special attention to improve job satisfaction and preserve resilience.

Disclosure

No significant relationships.

Psychological impact of pediatric cancer : a cross-sectional study among thirty parents

Introduction

The diagnosis of pediatric cancer is a traumatic event that is considered to be one of the most adverse situations the child and his family can experience. The psychological impact of this diagnosis on the parents has triggered a great scientific attention in these recent years.

Objectives

Estimate the prevalence of depression and post-traumatic stress among parents of children with cancer.

Methods

Our study was cross-sectional over a period of 1 month in the medical carcinology department at the Salah Azaeiz Institute. We used the Beck Depression Scale II and the Post Traumatic Stress Disorder Cheklist-Civilian assessements.

Results

Thirty parents participated in our study. Most of whom were mothers (73%). The educational level was primary in 63% of cases and socio-economic level was average in 60% of parents. 40% of parents were assessed within six months after diagnosis. Prevalence of depressive disorder and post-traumatic stress disorder were 73% and 57% respectively. The low educational level was correlated to the presence of these two disorders. Similarly, the low educational level was correlated to the presence of depressive disorders (p=0.008). The number of children in the family was also associated to the presence of post-traumatic stress disorder (p=0.029).

Conclusions

The prevalence of depressive and post-traumatic stress disorders was high among parents of children diagnosed with cancer. The low socio-economic and educational level and the large number of children in the family are risk factors for psychological distress. Psychosocial support should be offered to parents of children with cancer to optimize the management of this disease.

Disclosure

No significant relationships.

Psychological problems in tunisian children during the covid-19 pandemic

Introduction

The Covid-19 outbreak and the subsequent lockdown have profoundly impacted families’ daily life. Children may be among the most exposed to the psychosocial consequences of the pandemic.

Objectives

To assess the psychological well-being of children during the COVID-19 pandemic.

Methods

This was a descriptive study shared on social media during the period from 8 to 20 April 2021, targeting mothers of children aged 2 to 18 years. The first part included socio-demographic data of mothers and children. Then, to assess the behavior and coping skills of children and adolescents, we administered the Strengths and Difficulties Questionnaire (SDQ).

Results

Our study included 65 middle-aged moms = 35.28 years. Among mothers, 1.5% reported having at least one child with a psychiatric, medical or genetic illness. The average age of the children was 8.54 years, the sex ratio was 1.03 and they were in primary school in 52.3%. Moms had talked to their child about COVID in 93.8%, using scientific data in 69.4% of cases. The total average SDQ score was 10.82; and overall mental health was at risk in 15.4% of the children. They had risky emotional symptoms in 9.2%, risky aggressive behaviors in 12.3%, risky hyperactivity-inattention symptoms in 16.9%, relationship behaviors with at-risk pairs in 24.6%, and risky prosocial behavior in 9.2% of cases.

Conclusions

Researchers and government officials should be more concerned about the mental health of children who are often neglected as a result of the pandemic due to their comparatively lower mortality than older adults.

Disclosure

No significant relationships.

The assessment of family caregivers’ anxiety in pediatric epilepsy : a cross-sectional sudy

Introduction

Pediatric epilepsy is a debilitating disease that impacts not only children with epilpsy but also persons arround them. It is often considered as a source of anxiety for family caregivers.

Objectives

Assess the level of anxiety in caregivers of children with epilepsy and to identify factors related to it.

Methods

We conducted a cross-sectional, descriptive and analytical study between July and October 2020. It included caregivers of children with epilepsy hospitalized in the pediatric neurology department of Sfax. We used the STAI-Y scale to assess the level of state anxiety (STAI-AE).

Results

Forty four womens participated in our study. Low socio-economic level was found in 31.8% of cases. The average age of children was 4.9 years. The mean duration of epilepsy was 2.2 years. It was comorbid with an autism spectrum disorder or an intellectual disability in 15.9% of cases. In 70.5% of the cases, the children were dependent on their caregivers in their daily lives. The level of anxiety was moderate in 27.3% and high to very high in 13.6% of them. A higher state-anxiety score was correlated with a longer duration of epilepsy (p=0.033), a lower familial socioeconomic level (p=0.013) and a higher number of children in family (p=0.048).

Conclusions

Pediatric epilepsy is associated with significant level of anxiety in family caregivers. This anxiety increases with the duration of the disease and with the presence of socioeconomic and family difficulties. Thus, psychosocial support for caregivers should be integrated into a global approach of the disease.

Disclosure

No significant relationships.

Burden level among parents of children with epilepsy

Introduction

Family caregiving role of children with epilepsy involves managing the daily lives of these children with disabilities. This can lead to impaired physical and psychological health of the caregiver.

Objectives

To assess the level of burden among caregivers of children with epilepsy and to determine the factors associated with it.

Methods

It was a descriptive and analytical survey. It involved the caregivers of children with epilepsy who were admitted to the pediatric neurology department at the Hedi Chaker University Hospital in Sfax during the period from July to October 2020. We used the 12-item Zarit (ZBI-12), the State-Trait-Anxiety Inventory (STAI), and the “BECK” Depression Inventory (BDI-13) to assess caregiver burden, anxiety and depression respectively.

Results

Forty-four caregivers participated in the survey. Their average age was 36 years and their relationship with patient was mother in 93.2% of cases. Among 44 children with epilepsy, 56.8% were boys and 34.1% were schooled. They had psychiatric comorbidity in 15.9% of cases. According to the ZBI scale, the level of burden was high in 45.5% of cases. The total ZBI score was significantly higher among caregivers with primary school level (p=0.05) and those with somatic disease (p=0.004). It was not correlated with the presence of child’s dependence on the others (p=0.20). High levels of depression, anxiety-state, and anxiety-trait among caregivers were correlated with the level of burden (p 0.000; 0.000 and 0.001, respectively).

Conclusions

Being a caregiver of a child with epilepsy is a burdensome circumstance. Hence the importance of offering psychological assistance for these caregivers.

Disclosure

No significant relationships.

Factors related to Gaming addiction in adults

Introduction

With the advancement of technology over the last years, gaming is no longer reserved to adolescents. It has become a growing phenomenon within young adults which should,’t be overlooked as it is accompanied with the risk of addiction.

Objectives

To study the factors involved in video games addiction behaviors in adults

Methods

We conducted a cross-sectional, descriptive and analytical study. Data were collected using a self-administered questionnaire on social networks. We solicited adults between 18–40 years. We used the gaming addiction scale (GAS) in its validated Arabic short version.

Results

A hundred and nine participants were included. The mean age was 29.6 ±10.3 with a sex ratio of 1.5.The mean age of the beginning of regular gaming was 16.3± 8.64. we found that40.4% of our participants preferred the mode Massively Multiplayer Online Role Playing Games (MMORPG) while others played casual single player games. A play time of over 20 hours per week was reported by 11.9%of participants. According to the GAS, 25.7%were addicted gamers. Our participants spent an average of 7.94±6.71 hours before they play their first game of the day. We found that the score of Gas was significantly correlated to the male gender of the participants (p<0.000), a higher number of weekly gaming hours (p<0.000),a lower number of hours before gaming (P<0.000) and the mode of games (p<0.000).

Conclusions

Our study showed that contextual factors play an important role in understanding gaming addiction in young adults as a holistic phenomenon,embedding the problematic behavior within the context of the individual the game and gaming practices.

Disclosure

No significant relationships.

Burnout and associated factors among Tunisian medical interns and residents

Introduction

Burnout is an occupational psychological syndrome induced by chronic stress defined by three dimensions: emotional exhaustion (EE), depersonalization (DP) and reduced personal accomplishment (PA).

Objectives

Estimate burnout among residents and interns in Tunisia. Identify factors related to burnout.

Methods

We conducted a cross-sectional, descriptive, and analytical study between March 1 and April 15, 2021. Data collection among young physicians was done by a self-questionnaire published online. The assessment of the degree of burnout was done by the Maslach Burnout Inventory (MBI).

Results

The total number of participants was 56 of which 71.4% were women. The average age was 26.76 years. The pourcentage of the married was 21.4% of which 58.3% had children. 30.4% had parents in charge. Most of the participants worked in university hospitals and 75% of them in a medical department. Residents represented 64.3% of the participants. Number of working hours exceeded 40 hours per week in 60.7% of the cases with an average number of shifts per month estimated at 4.71±2.36. According to MBI, 94.6% of the participants had a score in favor of burnout, of which 19.6% was severe. The number of hours worked per week and the number of shifts per month were significantly associated with the presence of a burnout syndrome with respective correlation factors of 0.027 and 0.047.

Conclusions

Most residents and interns suffered from burnout with a variable degree of severity. The workload with a greater number of working hours and on-call duty favored the emergence of this burnout.

Disclosure

No significant relationships.

Mesenteric lipoma revealed by chronic abdominal pain: A rare case report

Mesenteric lipoma is a rare entity. It can be asymptomatic or revealed by unspecific clinical symptoms. Complete resection of the lipoma is often proposed to prevent complications. We report a case of mesenteric lipoma revealed by chronic abdominal pain, and we performed a literature review regarding this rare condition.

[Balloon catheter inflation with alkalinized lidocaine reduces post-operative laryngeal pain: a prospective, randomized controlled clinical trial]

Introduction

post-operative laryngeal pain (POLP) is frequent and embarrassing. The purpose of this study is to assess the efficacy of endotracheal tube balloon (ETB) inflation with alkalinized lidocaine in the prevention of the POLP.

Methods

we conducted a prospective, single-center, double-blind, randomized study including patients undergoing general anesthesia with tracheal intubation (OTI) with an expected duration of less than 240 min. Patients were divided into two equivalent groups: lidocaine (GL) group: patients with ETB inflated with alkaline lidocaine and the control group (GT): patients whose ETB was inflated with normal saline solution. The primary endpoint was the incidence of POLP in the first 24 hours after surgery and the secondary endpoint was the incidence of cough, dysphonia and postoperative vomiting, postoperative nausea and vomiting (PONV) in the first 24 hours after surgery. Statistical analysis was carried out using SPSS software version 25. The difference was considered significant when p< 0.05.

Results

the study included 60 patients randomized into 2 groups of 30 patients each. Both groups were comparable with regard to their demographic and anesthetic criteria. ETB inflation with alkalinized lidocaine reduced the incidence of POLP, cough, dysphonia and PONV. No cases of balloon rupture or lidocaine toxicity were reported.

Conclusion

ETB inflation with alkaline lidocaine prevents POLP.

Duplication cyst and diverticulum of the stomach: A case report of an unusual association

Gastric duplication cysts are uncommon findings in adult patients. Accurate diagnosis of these cysts is difficult. Presenting symptoms are often non-specific, and complications are rare. We report an uncommon case of a non-communicating duplication cyst associated to a diverticula of the stomach in 38-year-old women.

Facteurs prédictifs de fistule anastomotique après colectomie pour cancer

Introduction

en chirurgie du cancer colique, la fistule anastomotique (FA) est la complication la plus redoutée. Le but de cette étude était de déterminer les facteurs prédictifs de fistule anastomotique après résection pour cancer colique ainsi de décrire l´impact de cette complication sur la mortalité et la durée du séjour postopératoire.

Méthodes

nous avons mené une étude retrospective, descriptive et analytique, allant du 1^er janvier 2013 au 31 d écembre 2020, dans le service de chirurgie générale de l´Hôpital Habib Bourguiba de Sfax, Tunisie.

Résultats

nous avons colligé 163 malades opérés pour cancer colique. L´âge moyen était de 62,7 ans avec un sexe ratio de 1,36. Les suites opératoires étaient simples dans 64,4% des cas et compliquées dans 35,6%. La morbidité chirurgicale était essentiellement représentée par les fistules anastomotiques, identifiées chez 22 malades. Au terme de notre travail, il ressort que les facteurs prédictifs de la survenue de cette complication sont: le diabète avec un p = 0,04, le tabagisme avec un p = 0,01, l´hypoalbuminémie avec un p = 0,01, l´hémoglobine préopératoire inférieure à 10g/dl avec un p < 0,01, la localisation au niveau de l´angle colique gauche avec un p = 0,02, la transfusion peropératoire avec un p <0,01 et une durée opératoire supérieure à 180 min avec un p = 0,04. Par ailleurs, la survenue de FA était accompagnée d´un taux de mortalité spécifique de 9% et avait prolongé de façon significative la durée de séjour postopératoire.

Conclusion

la prévention de la FA doit s´inscrire dans le cadre d´une prise en charge multimodale du patient avec essentiellement un apport nutritionnel et une correction d´une éventuelle anémie en préopératoire.

[Role of laparoscopy in the diagnosis of peritoneal tuberculosis in an endemic area of Tunisia]

Tuberculosis is a public health problem in Tunisia. Tataouine governorate is an endemic area. Peritoneal involvement occurs in 1 - 2% of cases. We here report a retrospective, descriptive epidemiological study of 32 patients operated in the Department of Surgery at the Tataouine Hospital between 2010 and 2020. Laparoscopy was mainly performed (28 patients) to take biopsy samples for histologic confirmation of peritoneal tuberculosis. Twenty-four women and 8 men were involved in the study, with a M/F ratio of 0.33. The median age was 43 years, ranging from 14 to 78 years. Diagnostic laparoscopy was performed in 28 cases (87.5%). Given the intraoperative macroscopic aspect, the diagnosis of peritoneal tuberculosis was strongly suspected in 16 patients (50%). The anatomopathological study confirmed the diagnosis in all patients. The purpose of this study is to highlight the epidemiological, clinical features of peritoneal tuberculosis in an endemic region of Tunisia as well as the current role of laparoscopy as a rapid and effective diagnostic procedure.

[Hydatid cyst of the uterus: a rare localization]

We here report the case of B.J, an 83-year-old patient with no previous history, presenting with intermittent abdominal pain evolving over the last few months. Physical examination revealed the presence of a firm, subumbilical mass that was tender to palpation. Ultrasound showed two multivesicular hydatid cysts (Gharbi’s classification type 3) located in segments III and IV of the liver and multilocular right latero-uterine cyst. Serologic test was positive. Tumor markers were negative. Abdomino-pelvic computed tomography (CT) scan showed two adjacent multivesicular hydatid cysts in the left side of the liver measuring 60x40 mm (A), and a multivesicular right latero-uterine pelvic hydatid cyst measuring 110x80 mm pushing the bladder forward and the uterus to the left (B). Surgical exploration revealed the presence of left hepatic cysts (C) and a huge hydatid cyst arising from the right edge of the uterine body (D). Resection of the salient domes was performed. All the precautionary measures were implemented to avoid possible peritoneal dissemination. Anatomopathological examination confirmed the diagnosis of hydatid cysts. One-year CT scan did not show any local or peritoneal recurrence.

[Giant abdominal wall desmoid tumor: a case report]

Giant desmoid tumor has been rarely reported in the literature but it is a therapeutic challenge. We here report a case of tumor manifesting as painful abdominal mass causing a major esthetic problem. Radiological assessment allowed to determine its depth extension and limits of resection. Desmoid tumor of the abdominal wall was evoked and surgically resected, with simple outcome. This study highlights challenges in the management of this entity,due to its large size.

Perforated jejunal diverticulitis with extensive diverticulosis: A case report

Jejunal diverticulitis is a rare condition that almost occurs in the elderly. An extensive diverticulosis associated is exceptional and can make the treatment more challenging.

Laser utility in the treatment of hemorrhoidal pathology: a review of literature

Hemorrhoidal disease is a common reason for consultation in proctology. It can be treated in several ways (medical, endoscopic, and surgical). Laser treatment has been described since 1960 and has developed in recent years. The purpose of this literature review was to study the results of laser treatment of hemorrhoids and to compare them with those of surgical methods. We performed a systematic search of the literature by querying the Medline, Google Scholar, and Cochrane Library databases. Retrospective studies and case reports were excluded. We selected 11 studies both techniques HeLP (hemorrhoid laser procedure) and LHP (laser hemorrhoidoplasty procedure). The total number of patients was 1179 including 1059 patients treated with laser and 120 treated surgically within the context of comparative studies. The age of the patients varies between 18 and 74 years old. HeLP laser treatment was significantly superior to surgical treatment in terms of postoperative pain (p < 0.001), hemorrhoidal disease downgrading (p < 0.001), and postoperative satisfaction (p < 0.001). Similarly, LHP laser treatment was significantly superior to surgical treatment in terms of operative duration (p < 0.00001), intraoperative bleeding (p < 0.00001), postoperative pain at H12 and H24 (p < 0.00001 and p = 0.0003), and postoperative bleeding rate (p < 0.001). The laser represents a revolution in the field of proctology mainly in the treatment of hemorrhoidal pathology. It is a safe, effective, and less painful mini-invasive technique. More rigorous studies will be needed to better evaluate this technique.

[A rare cause of upper gastrointestinal bleeding: gastroduodenal artery pseudoaneurysm rupture]

A 69-year-old female patient with diabetes and hypertension on treatment presented in the emergency department with haematemesis. She reported intermittent epigastric pain evolving for a few days. Clinical examination only showed epigastric susceptibility. Laboratori tests revealed severe normocytic normochromic anemia (Hb=8.3 gr/dl), normal amylasemia with preservation of liver function and coagulation. Patient´s outcome was marked by decline in haemoglobin concentrations and haemodynamic instability despite good venous filling and blood transfusion. Given the nonavailability of urgent digestive endoscopy, abdominal angioscan showed gastroduodenal artery pseudoaneurysm measuring 6mm along its longer axis without signs of active leakage or intraperitoneal effusion, associated with choledocoduodenal fistula. The diagnosis of heavy upper gastrointestinal bleeding secondary to gastroduodenal artery pseudoaneurysm rupture was retained. The patient underwent emergency surgery given the nonavailability of arterial embolization through vascular ligation. Patient´s outcome was favorable with stabilization of haemoglobin level and hemodynamic status.

[Dermatofibrosarcoma protuberans (Darier-Ferrand) of the abdomen: a case report]

Dermatofibrosarcoma is a rare skin tumor. Morphological characteristics can be misleading and unknown to most of physicians. Diagnostic delay may affect patient´s management and prognosis. We here report the case of a young patient with lesions protruding from the abdominal wall mistaken for benign cysts. X-ray examination revealed subcutaneous adipose tissue mass. This was suspected of being a fibrosarcoma. The mass was resected with a macroscopic safety margin. The anatomo-pathological study confirmed the diagnosis of dermatofibrosarcoma. Clinical and radiological follow-up examinations didn´t show any recurrence. This study highlights the importance of suspecting this rare tumor requiring specialist treatment.

Depression in quarantined patients during the COVID-19 pandemic

Introduction

Quarantine for suspected patients of being infected by the COVID-19 can lead to negative consequences for mental health and the appearance of depressive symptoms.

Objectives

To assess the prevalence of depression in quarantined patients, and to analyze the associated factors.

Methods

This was a descriptive and analytical survey, carried out from April 4 to May 30, 2020, with 149 patients consulting the COVID-19 sorting box at the Hedi Chaker CHU in Sfax. Suspected COVID-19 patients were contacted by phone during their quarantine and invited to participate in our study. The Patient Health Questionnaire (PHQ-9) scale was used to assess the severity of depression. Cutoffs of 5, 10, 15, and 20 represent minimal, mild, moderate, moderately severe, and severe levels of depression based on PHQ-9 scores. A cutoff score of 10 determines major depression.

Results

The results showed a prevalence of major depression of 10.7%. Of all patients, 89.3% had minimal to mild depression; 10% had moderate to moderately severe depression and 0.7% had severe depression. The PHQ-9 score was statistically correlated with travel to a suspect area during the 14 days preceding the consultation (p = 0.008), contact with a subject confirmed COVID-19 (p = 0.01), previous follow-up in psychiatry (p = 0.047), the change of residence during quarantine (p = 0.045), the fear of transmitting the disease to relatives (p = 0.00) and the positive result of the nasopharyngeal swab (p = 0.00).

Conclusions

Psychological distress was felt in our patients. We recommend that necessary measures should be taken to combat depression.

Perceived stress among suspected patients during the COVID-19 outbreak in Tunisia

Introduction

Widespread outbreaks of infectious disease, such as COVID-19, are associated with psychological distress and symptoms of mental illness especially for patients with suggestive symptoms.

Objectives

Predict the prevalence of perceived stress and study associated factors among patients with suspected COVID-19 infection.

Methods

A cross sectional study was conducted between April and May 2020. Patients consulting the sorting box at the Hedi Chaker Hospital of Sfax and declared suspect to be infected by COVID-19 were invited to participate in our study after given their cosent. Perceived Stress Scale-10 was used to evaluate prevalence of perceived stress.

Results

In total, 149 participants participated. The mean age was 38.8±15.39 years. Medical or surgical history and psychiatric history were identified respectively in 30,2% and 12.1% of participants. Among all respondents, 74.5% took a nasopharyngeal swab to look for COVID-19 and only 6.4% had a positive test. Close contact with someone with a positive COVID-19 infection was found in 8.05%. Several participants (79,2%) expressed fear of transmitting the disease to their family members. The mean of the PSS-10 score was 11.97±9.83. Moderate to severe perceived stress was found in 44.3% of patients. Significantly higher scores were observed among participants with a positive pharyngeal swab for COVID-19 as well as those who perceived worry of transmetting the disease. No significant differences in perceived stress’ scores according to socio-demographic data.

Conclusions

Perceived stress was high among patients with suspected COVID-19 infection. Perceiving worry of transmetting the disease and having a positive pharyngeal swab for COVID-19 were the principal risk factors.

Disclosure

No significant relationships.

Impact of male infertility on self-esteem

Introduction

Infertile males experience considerable psychological distress, with feelings of inadequacy, marginalization, guilt and loss ofself-esteem.

Objectives

Our study aims to investigate the impact of male infertility on men’s self-esteem and to study risk factorsfor low self-esteem.

Methods

We conducted a cross sectional, descriptive and analytical study, including 108 infertile men who presented to the laboratory of reproductive biology and the unit of assisted medical procreation of Military Hospital of Tunis between June and September 2019. For each patient, we collected sociodemographic and clinical data. We used Rosenberg scale to assess self-esteem.

Results

The average age of participants was 36.8 years. Eleven patients had a history of varicocele (10.18%) and six of them sufferedfrom associated erectile dysfunction (5.55%). Infertility was primary in most of patients (77.8%) with an average duration of 3.32 years. 25% of patients had at least one previous failed assisted reproductive attempt. Spermogram abnormalities were found in 78.7% of patients. The mean score of Rosenberg scale was 30.68±4.35. Low self-esteem was associated with older age (p=0.006), lower educational level (p=0.019) and longer duration of infertility (p=0.022). Men who had children had better self-esteem (p=0.022). No associations were found between self-esteem and erectile dysfunction or previous failed assisted reproductive technique attempt.

Conclusions

Our results show that infertility reduces men’s self-esteem, especially of patients with lower educational level and longer duration of infertility. Physician dealing with infertility should be aware of these psychosocial aspects and offer help when needed.

Dépression unipolaire versus dépression bipolaire : facteurs prédictifs d’une évolution bipolaire

Bipolar and unipolar disorders share a common depressive clinical manifestation. It is important to distinguish between these two forms of depression for several reasons. First, prescribing antidepressors in monotherapy indubitably worsens the prognosis of bipolarity disorders. Second, postponing the prescription of a mood stabilizer reduces the efficacy of the treatment and multiplies the suicidal risks by two. The object of this study is to reveal the factors that distinguish between unipolar and bipolar depression. This is a retrospective study on patients' files. It includes 186 patients divided according to DSM IV criteria into two groups: patients with bipolar disorder type I or II with a recent depressive episode (123 patients) and patients with recurrent depressive disorder (63 patients). A medical record card was filled-in for every patient. It included socio-demographic data, information about the disorder, family antecedents, CGI score (global clinical impressions), physical comorbidity, substance abuse and personality disorder. In order to sort out the categorization variables, the two groups were compared using chi2 test or Fischer's test. With regard to the quantitative variables, the two groups were compared using Krostal Wallis's test or Ancova. Our study has revealed that bipolar disorder differs significantly from unipolar disorder in the following respects: bipolar disorder is prevalent among men (sex-ratio 2) while unipolar disorder is prevailing among women (sex-ratio 0.8); patients with bipolar disorder are younger than patients with unipolar disorder (38.1 +/- 5 years vs. 49.7 +/- years); the age at the onset of bipolar disorder is earlier than that of unipolar disorder (20.8 +/- 2 years vs. 38.7 +/- 5 years); family antecedents are more important in bipolar patients than in unipolar patients (51.1% vs. 33%). More importantly, bipolar disorder differs from unipolar disorder in the following aspects: The number of suicidal attempts (25.3% vs. 23.6%); the degree of substance abuse (15.4% vs. 14.5%); the level of somatic comorbidity (20.3% vs. 17.4%); the amount of anxiety manifestations (5.6% vs. 4.8%); the extent of personality disorder (30.8% vs. 23.8%); the degree of socio-professional impairment (bachelorhood and unemployment). On the other hand, we noted that unipolar patients differ from bipolar patients in terms of the frequency of hospitalizations (3.5 vs. 3.1) and the length of stays in hospitals (25.8 vs. 20.7 days) with significant differences of 0.003 and 0.0000001 respectively. Moreover, the CGI scores of unipolar patients are higher than those of bipolar patients. However, the difference is not significant. Consequently, an early distinction between bipolar and unipolar disorder is of utmost importance for the treatment of these two illnesses.

[Apnea disclosing Chlamydia trachomatis infection in a premature infant]

The authors report a peculiar type of maternofetal Chlamydia trachomatis (CT) infection in a 34 week-premature neonate. The revealing sign was the occurrence, at age 11 days, of frequent apneas with bradycardia, needing mechanical ventilation associated with adapted antibiotic therapy for 14 days. Diagnosis was confirmed by the isolation of CT in tracheal secretions. Immediate evolution was favorable. Literature data are reviewed and a short epidemiological survey is reported.

[Bilateral galactocele in an infant]

The authors report a case of a 2 month-old male baby with bilateral mammary gland swelling diagnosed as galactocele that resolved after simple puncture. Galactocele, or milk filled mammary gland cyst, is a possible complication of the neonatal genital crisis, but may also appear after the first months of life. This condition has been described only in males and was rarely noted in the literature. It should be considered as one of the possible causes of infantile gynecomastia.