Prognostic significance of tumor suppressor protein p53 in prostate cancer

INTRODUCTION

The p53 gene mutation is one of the most common genetic alterations in many cancers. In prostate cancer (PCa), it has been associated with a poor prognosis, tumor progression and aggressiveness. P53 mutation induces an abnormal protein expression in related tissues.

AIM

This study aimed to assess p53 expression using immunohistochemistry in PCa and to discuss its prognostic value.

METHODS

We have retrospectively collected all cases of PCa diagnosed in our pathology department between 2012 and 2022. An automatized immunohistochemical analysis was performed using monoclonal p53 antibody. For each case, we assessed the proportion of positive cells and the intensity of staining. P53 expression was considered abnormal when it was totally negative or overexpressed (>=50% of positive cells).

RESULTS

Twenty-four cases have been selected. Abnormal p53 expression was found in 42% of cases (P53 was overexpressed in 6cases and totally negative in 4 cases). Mean age of patients with p53 abnormal expression was 70years old. Patients with p53 abnormal expression had Gleason score >7 in 5 cases, ISUP grade >2 in 3 cases, peri-neural invasion in 8cases, capsule invasion in 9cases. All patients with p53 overexpression developed androgen resistance (p<0.01).

CONCLUSION

An aberrant expression profile of the p53 protein was observed in 42% of cases, and a statistically significant association was found with androgen resistance. Our results suggest a potential prognostic role of p53 in PCa.

Pediatric and adult osteoporosis: a contrasting mirror

Pediatric osteoporosis (PO) is a condition that is currently gaining recognition. Due to the lack of official definitions over the past few decades, the exact incidence of PO is unknown. The research does not provide a specific prevalence of PO in different world regions. However, this is expected to change with the latest 2019 guidelines proposed by the International Society of Clinical Densitometry. Although adult osteoporosis (AO) has been postulated a pediatric disease because its manifestation in adulthood is a result of the bone mass acquired during childhood, differences between PO and AO should be acknowledged. AO is defined as low bone density; however, PO is diagnosed based on existing evidence of bone fragility (vertebral fractures, pathological fractures). This is particularly relevant because unlike in adults, evidence is lacking regarding the association between low bone density and fracture risk in children. The enhanced capacity of pediatric bone for reshaping and remodeling after fracture is another difference between the two entities. This contrast has therapeutic implications because medication-free bone reconstitution is possible under certain conditions; thus, background therapy is not always recommended. In this narrative review, differences between PO and AO in definition, assessment, and medical approach were investigated.

Foot-related impairment in children with juvenile idiopathic arthritis

AIM

Foot involvement is present in approximately 60%-90% of children with Juvenile idiopathic arthritis (JIA). It is a major cause of disability, which can lead to deterioration in daily activities and quality of life. However, it is often overlooked and can compromise patient management.

PURPOSE

Our objective was to describe the ankle and foot involvement in JIA and to appraise the functional impact of this damage on the child's performance and quality of life by using validated scores.

METHODS

The cross-sectional study included patients with JIA. Functional impairment was assessed through the Juvenile Arthritis Functionality Scale (JAFS) and the Oxford Ankle and Foot Questionnaire for children.

RESULTS

Twenty-three patients aged 12.75 ± 3.9 and with 41 months of disease duration. After completing the Oxford score, the physical domain appeared to be the most altered. A long delay in diagnosis was associated with an alteration in the emotional domain of the Oxford score. Higher disease activity was significantly associated with impairment in both the physical activity and the footwear domains of the Oxford score. As regards clinical examination data, the presence of foot pain as well as the presence of tendinopathy were associated with an alteration of all Oxford score domains. The presence of flat feet significantly affected all domains of the Oxford score. The JAFS was reported to affect the child's performance ability and was associated with impairment in physical activity, school and play, and emotional domains.

CONCLUSION

Ankle and foot involvement was common in our study. Functional ability was most impaired in the lower limbs. High disease activity, foot and ankle pain, tenosynovitis, and flat feet were associated with poorer quality of life and higher functional impact.

Kidney biopsy in subsaharan Africa

Kidney biopsy (KB) is a significant advance in the management of nephropathies. In sub-Saharan Africa, few studies have been carried out. The objective of our study was to evaluate the indication, to determine the epidemiological and histological characteristics of the nephropathies diagnosed in sub-Saharan Africa.

Materials and methods

We carried out a retrospective and descriptive study on biopsies examined between January 2015 and December 2019, in the pathological departments of University Teaching Hospital of Bouaké and Cocody-Abidjan. The KB came from four countries (Côte d'Ivoire, Togo, Guinea-Conakry and Burkina Faso). Optical microscopy and/or direct immunofluorescence techniques were used. All biopsy samples including epidemiological, clinical and pathological data and an optical microscopy and/or direct immunofluorescence study were included. The parameters studied were indications for KB, epidemiological profile, clinic, proteinuria and pathological aspects.

Results

Over the study period, we collected 179 KB, i.e. 35.8 KB/year. The mean age of the patients was 32.9 ±13.8 years (range 11-70 years). The sex ratio (M/F) was 1.03. Pure nephrotic syndrome was the main indication (64.2 %, n = 115) for KB, followed by impure nephrotic syndrome (11.7 %, n = 21), acute renal failure (ARF) (7.8 %, n = 14) and rapidly progressive glomerulonephritis (RPGN) (7.8 %, n = 14). Glomerulonephritis (GN) occurred in 86 % (n = 158), vascular nephropathy in 11.7 % (n = 21) and tubulointerstitial nephritis in 2.2 % (n = 4). The nephropathies were preferentially focal segmental glomerulosclerosis (34.6 %, n = 62), nephroangiosclerosis (10.6 %, n = 19), membranous GN (10 %, n = 18), post-infectious GN (8.9 %, n = 16) and lupus GN (7.3 %, n = 13).

Conclusion

The KB is an essential step in the diagnosis of nephropathies. Focal segmental glomerulosclerosis is frequent in our study. The establishment of a Kidney registry would allow better knowledge of renal pathologies in sub-Saharan Africa.

Incidence and risk factors associated with development of oxalipatin-induced acute peripheral neuropathy in colorectal cancer patients

INTRODUCTION

Oxaliplatin utilized in colorectal neoplasms treatment could induce acute peripheral neuropathy (APN) which is a dreadful and frequent adverse event. The objective of this study is to estimate incidence of APN induced by oxaliplatin cumulative incidence in cancer patients colorectal and to describe the distribution of the APN incidence according to demographic and clinical characteristics, as well as according to oxaliplatin cumulative dose.

MATERIAL AND METHODS

This is a prospective descriptive study which took place from June to December 2018 at the Salah Azaiz Institute, Tunis. Demographic data, clinical data and data on oxaliplatin administration were collected from patient interview, medical files and pharmaceutical databases.

RESULTS

The APN (grade 1, grade 2 and grade 3) cumulative incidence during the period of six months of follow up was 86% (95% CI [0.7815-0.9132]). While 38.3% (95% CI [0.29-0.48]) of the patients had grade 2 or 3 neuropathy. The search for factors associated with the risk of grade 2 and 3 NAP revealed trend significant association with diabetes (adjusted RR = 5.7 (IC95% [0.9- 37.3]; p = 0.07). Moreover, there was significant association with oxaliplatin cumulative dose (≥421 mg/m2) to increase the risk of APN grade 2 and 3 (adjusted RR = 7.8; [2.7-22.7]; p = 0.0001). Furthermore, significant association with obesity to increase the risk of APN grade 2 and 3 (adjusted RR = 5.3 [1.1- 25.4]; p = 0.04) was found. Among the patients included, 31.1% experienced oxaliplatin dose reduction and in the majority of cases this reduction is due to neurotoxicity (90.9%).

CONCLUSION

The high incidence of oxaliplatin-induced APN remains an embarrassing and handicapping side effect. Our study has shown that oxaliplatin cumulative dose (≥421 mg/m2), diabetes and obesity are risk factor for the development of grade 2 and 3 APN.

Incidence and risk factors of SARS-CoV-2 infection among workers in a public health laboratory in Tunisia

The aim of this study was to measure the extent of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among workers at the Institut Pasteur de Tunis (IPT), a public health laboratory involved in the management of the COVID-19 pandemic in Tunisia, and to identify risk factors for infection in this occupational setting. A cross-sectional survey was conducted on IPT workers not vaccinated against coronavirus disease 2019 (COVID-19). Participants completed a questionnaire that included a history of reverse transcription-polymerase chain reaction (RT-PCR)-confirmed SARS-CoV-2 infection. Immunoglobulin G antibodies against the receptor-binding domain of the spike antigen (anti-S-RBD IgG) and the nucleocapsid protein (anti-N IgG) of the SARS-CoV-2 virus were detected by enzyme-linked immunoassay (ELISA). A multivariate analysis was used to identify factors significantly associated with SARS-CoV-2 infection. A total of 428 workers were enrolled in the study. The prevalence of anti-S-RBD and/or anti-N IgG antibodies was 32.9% [28.7-37.4]. The cumulative incidence of SARS-CoV-2 infection (positive serology and/or previous positive RT-PCR test) was 40.0% [35.5-44.9], while the proportion with asymptomatic infection was 32.9%. One-third of the participants with RT-PCR-confirmed infection tested seronegative more than 90 days postinfection. Participants aged over 40 and laborers were more susceptible to infection (adjusted OR [AOR] = 1.65 [1.08-2.51] and AOR = 2.67 [1.45-4.89], respectively), while tobacco smokers had a lower risk of infection (AOR = 0.54 [0.29-0.97]). The SARS-CoV-2 infection rate among IPT workers was not significantly different from that detected concurrently in the general population. Hence, the professional activities conducted in this public health laboratory did not generate additional risk to that incurred outside the institute in day-to-day activities.

Predictive factors of difficult biliary cannulation: An experience of a tunisian tertiary center

Introduction

Selective biliary cannulation is a prerequisite for a successful endoscopic retrograde cholangiopancreatography (ERCP). However, conventional biliary access can be difficult. The aims of our study were to determine the prevalence of difficult biliary cannulation (DBC) and its associated factors and to describe the efficiency and safety of used standard and advanced cannulation techniques.

Methods

We conducted a single-center retrospective study including all patients with naïve papilla who had an ERCP procedure in Gastroenterology department of Mohamed Taher Maamouri Hospital from June 2019 to December 2021. Efficiency was defined as successful selective deep biliary cannulation. DBC was defined based on the presence of one or more of the European Society of Gastrointestinal Endoscopy (ESGE) criteria (5-5-1): more than five cannulation attempts, more than 5 min before cannulation and more than one accidental passage in the wirsung. Prevalence was measured using ESGE 5-5-1 cutoffs and chinese set cutoffs 15-10-2. Predictors of DBC were sought by univariate and multivariate analysis (SPSS software, p significant if < 0.05).

Results

We included 664 patients (mean age 62 years and sex ratio M/W = 0.8). Main indication for ERCP was choledocholithiasis (67%, n = 442) followed by malignant biliary stenosis (21%, n = 138). Based on ESGE criteria, prevalence of DBC was 42.62% (n = 283). Prevalence was 21.15% when 15-10-2 cutoffs are applied in trainee-involved procedure. Cumulative biliary success rate was 96.46%. Standard cannulation method achieved access in 98.2% while advanced methods permitted success in 92.2% in fistulotomy, 94.1% in papillotomy and 77.3% in transpancreatic sphincterotomy. Independent predictive factors of DBC in multivariate analysis were: Trainee presence OR 1.80 [1.24-2.65], SOD OR 4.71 [1.11-19.88], biliary stenosis found on imaging examinations (OR 2.53 [1.63-3.92], small papilla OR 4.09 [1.82-9.17] and difficult orientation of the papilla OR 14.90 [3.28-67.62].

Conclusion

DBC is a frequent endoscopic situation. Predictors of DBC can be related to trainee involvement in the procedure, anatomical and clinical factors. A thorough understanding of these factors can actively contribute to ERCP management plans.

Pediatric synchronous multifocal and disseminated cerebrospinal classic medulloblastoma revealed by bilateral decreased visual acuity: a case report

Medulloblastoma (MB) is a rapidly growing malignant solid tumor that arises from stem cells located in the subependymal germinal matrix or outer granular layer of the cerebellum. It represents 15 to 30% of pediatric brain tumors and less than 1% of primary brain tumors. The reason for the high incidence of MB in children compared to adults is the embryonic origin of the tumor. In typical cases, MB manifests as a solitary lesion in the fourth ventricle or in the cerebellar parenchyma; cases of synchronous multifocal and disseminated MB are quite rare in patients without familial tumor syndromes. To date, only 7 cases in adults and a single pediatric case with Gorlin syndrome have been described previously. Here, the authors report a new case of synchronous multifocal classic cerebrospinal histologically confirmed MB in a 10-year-old male patient revealed by bilateral decreased visual acuity without any other localizing neurological signs. The authors will proceed with a review of the current literature regarding this rare entity.

Hydatid cyst in the third ventricle of the brain: case report of an exceptionally rare condition

Hydatid disease is an endemic zoonotic disease caused by the cestode Echinococcus multilocularis and Echinococcus granulosus. Intra-ventricular hydatid cysts are extremely rare. Even more rarely, and to the best of our knowledge, only three cases of third ventricle involvement have been reported. Herein, we present the fourth case of an intraventricular hydatid cyst in a pediatric patient located in the third ventricle. It is about a 7-year-old girl, of a rural origin, admitted for intracranial hypertension, deterioration of the general status, and weakness on the right side of her body. A cerebral magnetic resonance imaging (MRI) showed the presence of a rounded cystic formation in the third ventricle. The patient was operated through a transfrontal transventricular approach, and the cyst was removed. Postoperative course was uneventful. Hydatid disease should be considered part of the differential diagnosis for cystic lesions of the central nervous system, especially in endemic regions. Total removal of the cysts without rupture is a challenge, but best treatment remains an active nationwide prevention.

Mortality attributable to tobacco in Tunisian adults, 2016Mortalité attribuable au tabac dans la population tunisienne adulte en 2016

OBJECTIVE

We aimed to estimate the mortality attributable to current cigarette smoking among Tunisian individuals aged 30 years and over in 2016.

METHODS

The number of deaths attributable to cigarette smoking was estimated using the population attributable fraction (PAF) method of calculation. Current cigarette smoking-related data and number of deaths by cause were obtained from a Tunisian national household survey conducted in 2016 (THES-2016) and the "Global Burden of Disease" study respectively. Relative risks for cause-specific mortality among current cigarette smokers compared to never-smokers were obtained mainly from the American cancer prevention study II (CPS II), including adjustments for a range of potential confounders.

RESULTS

In 2016, 6,039 deaths were attributed to current cigarette smoking (5,934 in men and 105 in women), accounting for 14.3 % of total deaths in persons aged 30 years and over (24.2 % in men and 0.6 % in women). Lung cancer, chronic obstructive pulmonary diseases and upper aerodigestive tract cancers represented the highest smoking-attributable risks (74.5 %, 49.1 % and 42.2 % respectively).

CONCLUSIONS

In the present study, high rates of smoking-attributable mortality were found, mainly among men. In addition to more rigorous application of existing laws, sensitization to the dangers of tobacco, educational anti-smoking campaigns and help in quitting are of prime importance.

Incidence cumulée de l'infection au SARS-CoV-2 à l'Institut Pasteur de Tunis, mars 2021

Contexte

L'Institut Pasteur de Tunis (IPT) a été impliqué dans les activités de diagnostic biologique de l'infection par le SARS-CoV-2. De nombreux cas d'infection par le SRAS-CoV-2 ont été détectés parmi le personnel de l'IPT, mais la véritable propagation de l'infection au sein de cette institution était inconnue. Notre étude visait à mesurer l'étendue de l'infection par le SRAS-CoV-2 parmi les agents de l'IPT et de déterminer la proportion d'infections asymptomatiques.

Méthodes

Une enquête transversale exhaustive auprès des agents de l'IPT non encore vaccinés contre la COVID-19 a été menée au cours des deux dernières semaines de mars 2021 qui coïncidaient avec la fin de la deuxième vague de COVID-19 en Tunisie. Les échantillons de sérum collectés auprès des participants ont été testés à l'aide de deux tests ELISA développés à l'IPT pour détecter les immunoglobulines G dirigés contre le domaine de liaison au récepteur (RBD) de la protéine de pointe S (IgG anti-S-RBD) et contre la protéine de nucléocapside N (IgG anti-N) du virus SARS-CoV-2.

Résultats

Au total, 428 personnes ont été incluses dans l'étude. La prévalence des anticorps anti-SARS-CoV-2 (IgG anti-N et/ou IgG anti-SRBD) était de 32,7 % (intervalle de confiance 95 % : [28,0-36,9]) (22,2 % [18,2-25,9] avaient des IgG anti-N et 31,3 % [26,9-35,7] avaient des IgG anti-S-RBD). L'incidence cumulée de l'infection par le SRAS-CoV-2 (sérologie positive et/ou test RT-PCR antérieur positif) était de 39,7 % [35,0-44,2]. La proportion de formes asymptomatiques était de 32,9 %.

Discussion/Conclusion

s Nos résultats ont révélé une incidence relativement élevée d'infection par le SARS-COV-2 parmi les agents de l'IPT. Les échantillons recueillis avant la vaccination seraient très utiles pour les enquêtes séro-épidémiologiques de suivi post-vaccinal. La proportion considérable d'infections asymptomatiques souligne l'importance de l'intensification de la pratique des tests de dépistage pour rompre la chaine de transmission de l'infection.

Déclaration de liens d'intérêts

Les auteurs déclarent ne pas avoir de liens d'intérêts.

Spontaneous rapid regression of a juvenile primary aneurysmal bone cyst of the skull: A case report and literature review

Aneurysmal bone cyst (ABC) is a benign lesion that often starts off the metaphysis of long bones and which, as it grows, may blow out bone. Only 3%-6% of cases are located in the skull. Spontaneous recovery has been reported. These cases occur more often in adults and in pelvic locations. Spontaneous regression at the skull level remains a very rare entity and few cases were described in the literature. Here, the authors report another case of spontaneous rapid regression of ABC of the skull in a 7-year-old boy revealed by gradually increasing painless hard swelling in the right frontal bone region with rapid spontaneous regression within 15 days. The authors will also proceed with an overview concerning this rare entity.

Mental health status of adults under institutional quarantine: a cross-sectional survey in Tunisia

Introduction

restrictive measures imposed during the COVID-19 pandemic, such as quarantine, may induce psychiatric outcomes among concerned individuals. The present study aimed to describe the mental health status of Tunisian adults under mandatory institutional quarantine imposed during the COVID-19 pandemic, and to determine factors influencing the occurrence of psychiatric symptoms.

Methods

a cross-sectional phone survey was conducted from April to November 2020 using convenience sampling of persons who had experienced mandatory institutional quarantine. A standardized questionnaire was administered to participants including questions about socio-demographic characteristics and quarantine related information. Generalized anxiety disorder, depression symptoms, and sleep quality during quarantine were assessed using, respectively, the generalized anxiety disorder-7 (GAD-7), the centre for epidemiological studies depression (CES-D-10) and the insomnia severity index (ISI) scales. Bivariate and multivariate analyses were performed to determine factors associated with anxiety and/or depression and with clinical insomnia.

Results

among 506 participants, 38.3% experienced anxiety and/or depression symptoms (anxiety: 15.4%; depression: 37.4%) and 19.2% had clinical insomnia. The prevalence of anxiety and/or depression symptoms and insomnia were higher among women those who spent three hours or above on COVID-19 news, those who had economic difficulties due to COVID-19 pandemic, those who were not satisfied by the accommodation conditions of quarantine facilities, and those who had experienced stigma.

Conclusion

high prevalence of psychiatric symptoms among quarantined individuals was found in this study. Psychological interventions should thus be an integral part of the COVID-19 control strategy in order to provide adequate psychological support to persons quarantined due to COVID-19.

Prevalence and risk factors of trastuzumab induced cardiotoxicity in Tunisian HER2-positive breast cancer patients

INTRODUCTION

Cardiotoxicity is the most important side effect of Trastuzumab treatment. The purpose of this study is to evaluate the prevalence of Trastuzumab induced cardiotoxicity and to analyze risk factors associated with this side effect.

MATERIALS AND METHODS

A retrospective institutional study was carried out from June 2018 to December 2018 at the department of Medical Oncology of Salah Azaiz institute, Tunis, Tunisia. Demographic, clinical characteristics (menopausal status, breast cancer stage, anthracyclines exposure, comorbidities presence…) and left ventricular ejection function (LVEF) measurements, were collected from patient records.

RESULTS

Twenty-three women (20%) had Trastuzumab induced cardiotoxicity.65.2% (N = 15) experienced a decrease in LVEF more than 10% with a decrease below normal value and 34.8% (N = 8) experienced a decrease in LVEF more than 20%. Obesity is a risk factor for the occurrence of Trastuzumab induced cardiotoxicity (adjusted odds ratio (OR) = 2.919 (95% confidence interval (CI) [1.0411-8.186]; p = 0.042).

CONCLUSION

Our study highlighted that obesity is associated with a high risk of cardiotoxicity in women treated with Trastuzumab. Therefore, close monitoring of cardiac function is recommended especially for obese women during Trastuzumab administering.

Case report of Osteopoikilosis in patient with psoriatic arthritis

Osteopoikilosis (OPK) is one of the rare genetic musculoskeletal, non-inflammatory disorders that we should increase awareness toward. We report a case of a patient diagnosed with psoriatic arthritis with incidental imaging findings of lesions suggestive of osteopoikilosis.

Factors associated with the inflammatory process in pain in ankylosing spondylitis

Introduction

sleep disorders, closely related to any chronic pain process, are frequent among patients with rheumatic diseases, mainly ankylosing spondylitis (AS). Our study aimed to determine the association between sleep disturbances and the inflammatory process in pain in AS patients compared with lower back pain (LBP) patients. We have additionally examined factors associated with sleep disorders among AS patients.

Methods

we conducted a cross-sectional study among AS patients. Sociodemographic data, patient reported outcomes and disease characteristics were recorded. Sleep was assessed using the medical outcomes study sleep scale measure (MOS-SS). For psychological assessment, Beck anxiety (BAI) and depression index (BDI) was used. A multivariate logistic regression was performed to identify factors associated with sleep disorders.

Results

the study included 50 patients with AS and 40 patients with low back pain. The most common affected domains among AS patients were inadequacy, sleep disturbance, and daily somnolence. The MOS-SS index was significantly higher in the AS group than in the control group (p<0.001). Sleep disorder was associated with age, female gender, analphabetism, patient-reported outcomes (all p<0.05), but was not associated with profession, comorbidities and smoking habits. In multivariate analysis, factors associated with sleep disruption were the duration of morning stiffness (MS), disease activity, bath ankylosing spondylitis metrology index (BASMI), ASQol, as well as anxiety and depression (odds ratio: 5.4(CI 95% 1.6-18.3), 9.9 (CI95%1.1-86); 6 (CI95%1.1-32); 13 (CI 95% 1.4-143.8); 15.7 (CI 95% 2.6-94.3); 14 (CI 95% 2-105.7) respectively, p<0.05 for each).

Conclusion

our study highlighted the importance of sleep disorders among patients with AS with a predilection for inadequacy, sleep disturbance, and daily somnolence. Factors associated with sleep disruption were high disease activity, a longer duration of MS, an altered function and quality of life as well as anxiety and depression.

Influenza vaccination knowledge, attitudes, and practices among Tunisian elderly with chronic diseases

BACKGROUND

Generally, seasonal influenza does not cause severe infection in healthy adults, but for the elderly, an infection can pose a serious health concern. Although several measures can help prevent influenza, vaccination is considered the most effective. This study aimed to assess influenza vaccine uptake among elderly with chronic diseases in Tunisia during the 2018-2019 influenza season, and to identify knowledge, attitudes and barriers associated with influenza vaccine uptake.

METHODS

During influenza season of 2018-2019, we conducted a national cross-sectional study among elderly with chronic disease who were attending primary and secondary health care facilities in Tunisia. We collected data regarding practices, general knowledge and attitudes related to influenza and influenza vaccine, using a standardized questionnaire. A multivariate analysis by logistic regression was performed to assess the factors influencing willingness to receive influenza vaccine.

RESULTS

Among the 1191 surveyed elderly, 19.4% (95%CI 14.1-21.9) were vaccinated during the 2018-2019 influenza season and 64.7% (61.9-67.3) expressed willingness to be vaccinated in the next season regardless of vaccination status in the 2018-2019 season. Previous vaccination in the 2018-2019 influenza season was the most significantly associated factor with willingness to receive influenza vaccine (adjusted OR = 16.5 [3.7-72.4]). Significant associations were also observed between knowledge of influenza severity for the elderly as well as for those with chronic diseases and willingness to be vaccinated (p < 0.01). Likewise, participants who were convinced by flu vaccine effectiveness and those who were not concerned about vaccine side effects were more likely to be vaccinated (p < 0.001). The main reason that may lead to vaccine acceptance was a doctor's recommendation (41.1%), while the two main reasons that may lead to vaccine refusal were concerns about side effects (71.5%) and a belief that vaccine was ineffective in averting influenza illness (33.9%). Doctors were the most trusted source for information about influenza vaccine (91.5%).

CONCLUSION

Our study revealed low influenza vaccination coverage among Tunisian elderly with chronic diseases believed to be at higher risk for severe acute respiratory infections and death if infected with influenza. Treating physicians' role in promoting influenza vaccination in this high-risk group seems to be crucial.

COVID-19 Vaccination Acceptance and Its Associated Factors among Cancer Patients in Tunisia

BACKGROUND

Vaccination is the most effective way to fight the COVID-19 pandemic and to protect people who have a higher risk of developing severe illness and death from COVID-19 such as cancer patients. We aimed in this study to determine the acceptance rate of COVID-19 vaccination of the Salah Azaiez Institute (SAI) of cancer of Tunisia patients and to identify its associated factors.

METHODS

It was a cross sectional study about patients admitted to the SAI for treatment during the month of February 2021. Univariate and multivariate analyses were performed to identify factors associated with the COVID-19 vaccine acceptance among Tunisian cancer patients.

RESULTS

A total of 200 patients were included in this study with a mean age of 54.4±12.7 years and a gender ratio of 0.5. Only 35.0% of surveyed patients reported their acceptance to receive the COVID-19 vaccine. Multivariate analysis showed that believing in COVID-19 vaccine safety and efficacy (OR=3.1 [1.3-7.4]), enrollment in the COVID-19 vaccine platform (OR=8.3 [1.8-38.1]) and the willingness to receive influenza vaccine (OR=3.9 [1.6-9.3]) were independently associated with the COVID-19 vaccine acceptance among SAI cancer patients.

CONCLUSIONS

The COVID-19 vaccine acceptance rate found in this study was low. Communication strategies of the vaccination campaigns should provide clear, simple and detailed messages about the efficacy and the benefits of the COVID-19 vaccines. More engagement of health authorities to promote COVID-19 vaccination is necessary.

Assessment of COVID-19 vaccine literacy among cancer patients: A cross sectional Tunisian study

Background

In the context of the COVID-19 pandemic, Vaccine literacy (VL) is considered as an important determinant of vaccine hesitancy and uptake. Cancer patients constitute a target group for COVID-19 vaccination. Thus, we aimed in this study to assess COVID-19 VL among cancer patients in Tunisia.

Methods

A cross sectional study was conducted, during the month of February 2021, in the Salah Azaiez institute of cancer including all inpatients aged ≥18 years. A standardized VL scale was used, composed of two dimensions: functional VL and interactive-critical VL, using a four point Likert scale. A global score was calculated for each scale (ranging from 1 to 4); A cutoff of 2.5 was defined according to the literature. The students' t and Anova tests were used for comparison of VL mean scores according to the studied characteristics. A p value &lt;0.05 was considered as statistically significant.

Results

A total of 200 patients were enrolled in this study with a mean age of 54.4±12.7 years. A low VL score (≤ 2.5) was observed among 27.5% and 81.0% participants for functional and interactive critical scales respectively. Higher functional VL score was associated with a higher educational level (3.7±0.5 among individuals with a university degree level vs 2.5±1.2 among illiterate, p &lt; 0.001). Interactive critical VL significantly increased with educational level (p &lt; 0.001) and was significantly higher among healthcare workers (2.5±1.3 vs 1.7± 0.9, p &lt; 0.001), those who accepted to get the COVID-19 vaccine (2.0±0.9 vs 1.6±0.8, p = 0.002), who did not believe that vaccines are unsafe (1.9±0.9 vs 1.4±0.7, p &lt; 0.001) and that there is no need to be vaccinated since natural immunity exists (2.1±1.0 vs 1.7±0.8,p=0.016).

Conclusions

Vaccine literacy among cancer patients included in this study is weak. Effective communication strategies about COVID-19 vaccination should build VL and consider the level of patient's health literacy to redress vaccine hesitancy and uptake.

Key messages

This study showed a low interactive-critical vaccine literacy score. Communication strategies in vaccination campaigns should be aligned with people’s vaccine literacy.

Determinants of healthcare workers’ willingness to receive the influenza vaccine in Tunisia

Background

Influenza is a contagious respiratory disease that may lead to severe illness. Given their frequent contact with ill individuals, healthcare workers (HCWs) are at elevated risk of developing influenza and of transmitting the disease to their patients. We aimed in this study to assess flu vaccination intention among Tunisian HCWs and to identify its determinants.

Methods

A cross sectional study was conducted among Tunisian HCWs with direct patient contact during the 2018-2019 influenza season. Participants were recruited in primary and secondary healthcare facilities according to a self-weighted multistage sampling. Factors associated with influenza vaccination intention were assessed using a multivariate logistic regression analysis.

Results

In this study, 1231 HCWs were enrolled with a mean age of 44.5±9.3 years and a sex ratio equal to 0.25. Among respondents, 43.1% (95% CI: [40.0-45.8]) declared their willingness to receive the IV if recommended for HCWs and provided for free. Participants who received the IV during the 2018-2019 influenza season ((ORa=34.42 [16.41-72.21]), who knew that IV is indicated annually for HCWs (ORa=1.66 [1.21-2.30]), who had high confidence regarding IV efficacy (ORa=1.99 [1.48-2.68]), who believed that IV should be mandatory for HCWs (ORa=2,36 [1.76-3.18]) and that HCWs' vaccination against influenza is important in order to protect patients (ORa=1.92 [1.37-2.69]) were more likely to be willing to receive the IV. However, nurses were less likely to be willing to receive the vaccine than physicians (ORa=0.66 [0.44-0.98]).

Conclusions

Less than half of participants reported their willingness to receive the IV. Our results suggest that flu vaccination acceptance is associated with higher IV uptake and with favorable attitudes regarding influenza vaccination. This highlights the need to implement regular flu awareness campaigns in healthcare facilities aiming to encourage vaccination among HCWs.

Key messages

Majority of healthcare workers reported their unwillingness to receive the influenza vaccine. Educating health personnel about the benefits of influenza vaccination to themselves and their patients is necessary.

Trans fatty acids policy analysis to prevent non-communicable diseases in Tunisia

Background

Despite the widely published international guidelines for a better implementation of health policies promoting healthy eating habits; the epidemiological situation regarding most weighing heavily non-communicable diseases (NCDs) on global health, is still alarming. We aimed to analyze Tunisian health policies targeting trans fatty acids (TFA) consumption to prevent and control NCDs.

Methods

Based on in-depth policy content analysis and stakeholder interviews, Tunisian policies related to promoting healthy diets and restricting unhealthy consumption of TFA, were identified. Four sub-components of WHO best-buys were assessed: goal to eliminate industrially-produced TFA, legislation to ban their use in food chain, TFA labeling and fiscal policies, and mass media campaign to promote healthy diet and reduce TFA intake. Findings were analyzed based on three main axes of the “policy cube approach”: comprehensiveness of policy content, policy effectiveness and respect of equity principles. For each axis, final assessment was performed based on a Likert scale: low, moderate and high.

Results

Although (3/4) WHO best-buys are covered by the national strategies for NCDs and obesity prevention for 2018-2025 and 2013-2017 respectively. This analysis has revealed moderate level for comprehensiveness of policy content, because ofthe absence of specific mention regarding legislation. A moderate level in policy salience and effectiveness was also highlighted (weak accountability mechanisms and no budget line for effective implementation for all WHO best-buys). A very low respect to equity principles was also underlined with no specific attention regarding vulnerable populations.

Conclusions

Main weaknesses in TFA policies concerned legislation, budget allocation and accountability mechanisms. “Legislation measures” to ban trans-fats use in the food chain and resource mobilization for “nutrition labeling and mass-media campaigns” effective implementation, are recommended.

Key messages

Several weaknesses in TFA policies have been highlighted, mainly related to: legislation, budget allocation, accountability mechanisms and low respect to equity principles. Legislation reinforcement and efficient resource mobilization for “nutrition labeling and mass-media campaigns” effective implementation, are strongly recommended.

Attitudes and beliefs regarding current vaccines among Tunisian cancer patients

Background

Vaccines constitute a successful and cost-effective public health tool. Whereas, skepticism regarding their safety and efficacy remains prevalent. We aimed in this study to assess attitudes and beliefs regarding current vaccines among cancer patients in a national Tunisian center for cancer care.

Methods

A cross sectional study was conducted, during the month of February 2021, among hospitalized patients in the oncology unit of the Salah Azaiez Institute of cancer. We included patients who were aged 18 years and over and who were able to respond to the questionnaire. A standardized questionnaire was administered to patients to assess their attitudes and beliefs regarding current vaccines. Chi square test was used for comparing percentages and a p value <0.05 was considered as statistically significant.

Results

A total of 200 patients were included with a mean age of 54.4±12.7 years. The willingness to receive influenza and COVID-19 vaccine were respectively of 39.0% and 35.0%. A higher proportion of 69.0% was observed for the willingness to receive vaccines against other infectious diseases. Among surveyed patients, the high majority (81.0%) agreed with the fact that there is no need to be vaccinated because native immunity exits and or because vaccines are unsafe. This belief was significantly associated to patients' unacceptance of COVID-19 (91.3% vs 63.8%, p < 0.001), influenza (86.8% vs 72.7%, p = 0.013) and other infectious diseases vaccines (93.5% vs 75.9%, p = 0.003).

Conclusions

This study reported low acceptance proportions of influenza and COVID-19 vaccines and that false beliefs constitute a threat to vaccine acceptance. Healthcare professionals should educate and encourage cancer patients to be vaccinated, especially against COVID-19, influenza and pneumococcal infections.

Key messages

Low acceptance proportions of influenza and COVID-19 vaccines, were found in this study.

Improving communication strategies in order to redress false beliefs and increase vaccine acceptance is recommended.

Impact of mandatory institutional quarantine on sleep quality: A cross sectional Tunisian study

Background

Given the COVID-19 pandemic, Tunisian authorities have imposed quarantine in dedicated centers mainly for travelers coming from countries with highest coronavirus infection rates. Such restrictive measures may have a detrimental impact on people's mental health and can thus affect sleep. We aimed in this study to assess the impact of mandatory institutional quarantine on sleep quality in Tunisia and to determine factors associated with clinical insomnia.

Methods

Data were collected through a cross sectional study conducted from April to November 2020 among individuals who were in quarantine for 14 days including at least a week in a Tunisian quarantine center. Sleep quality was assessed using the Insomnia Severity Index. Factors associated with clinical insomnia were assessed using bivariate and multivariate analysis.

Results

In the present study, 506 participants were included with a mean age of 37.6±13.6 years. Majority (66.4%) were men. Nearly one fifth (19.2%) of surveyed individuals had symptoms of clinical insomnia. In multivariate analysis, we found that being a woman, spending longer time on covid-19 news per day, having experienced stigma during the quarantine period, financial difficulties due to the coronavirus pandemic and dissatisfaction by the accommodation conditions of the quarantine facility were independently associated with clinical insomnia.

Conclusions

Nearly one fifth of participants had clinical insomnia during the quarantine period. Providing a good sleep environment, educating sleep healthy behavior and giving adequate psychological support to quarantined individuals in quarantine centers is necessary.

Key messages

Among surveyed participants, 19.2% had symptoms of clinical insomnia.

Providing a good sleep environment in quarantine centers and providing mental health support to quarantined individuals is essential.

Cancer mortality attributable to cigarettes smoking in Tunisian adults, 2016

Background

The carcinogenic effect of tobacco smoking has been well established. In Tunisia, cancers ranked second leading cause of deaths from non-communicable diseases in 2014. In addition, Tunisia is classified among North African countries with the highest prevalence of tobacco smoking. We aimed in this study to estimate cancer mortality attributable to current cigarettes smoking among Tunisian adults aged 30 years and older in 2016.

Methods

Cancer mortality attributable to current cigarettes smoking was estimated using the population attributable fraction method. This estimation requires to have the number of deaths by cause, age and gender, the prevalence of tobacco use by age and gender, and the relative risks (RR) as measure of associations of tobacco use and diseases related to tobacco. The age and cause specific number of deaths were obtained from the health metrics database. The relative risks were mainly obtained from the Cancer Prevention Study II and the prevalence of current cigarettes smoking in Tunisia was taken from the Tunisian Health Examination Survey, a nationally representative household survey conducted in 2016.

Results

In 2016, 2410 and 31 deaths among Tunisian men and women respectively were attributable to current cigarettes smoking accounting for 54.3% and 1.7% of all deaths from cancers. Among neoplasms, lung and upper aerodigestive tract cancers had the highest proportion of deaths attributable to tobacco smoking. They were responsible for 1702 and 392 deaths attributable to current cigarettes smoking corresponding to 74.5% and 49.1% of the total number of deaths from lung and upper aerodigestive tract cancers respectively.

Conclusions

More than half of cancer deaths among Tunisian men were attributable to current cigarettes smoking. The enforcement of smoking free legislation and the promotion of smoking cessation interventions are thus necessary.

Key messages

Majority of all cancer deaths observed among Tunisian men aged 30 years and over in 2016 were attributable to current cigarettes smoking. Lung cancer had the highest proportion of deaths attributable to Tobacco.

Assessment of glycemic control among Tunisian diabetic adults

Background

Diabetes, a major public health issue in Tunisia, is responsible of an increased burden of morbidity and premature mortality. Achieving a good glycemic control is essential for reducing the morbidity-mortality associated with this disease. The purpose of our study was to assess the proportion of uncontrolled diabetes (UD) among Tunisian diabetic adults and assess associated factors.

Methods

A national household survey, stratified at three degrees, was conducted in 2016. As part of this study, we included previously diagnosed diabetic adults aged 20 years or above. Sociodemographic data and medical history were collected using an individual questionnaire, and glycated hemoglobin (HbA1C) was measured using the “A1C Now +” device. The UD was defined based on the American Diabetes Association criteria for the year 2016 (HbA1c ≥7%). Multiple logistic regression model was used to determine factors associated with UD. Adjusted Odds Ratios (AOR) were presented with 95% confidence intervals (CI). All data analysis was performed using SPSS software.

Results

A total of 873 subjects were included with a median age of 61 years and a sex-ratio equal to 0.9. The proportion of UD was (72.8%, 95% CI: [69.1-76.3]). In multivariate analysis, UD was more frequent among rural areas residents (AOR=1.8 [1.1-2.7]), those who had never seen a doctor within the year preceding the survey (AOR=2.2 [1.1-4.2]) and among those on oral antidiabetics (AOR=6.1 [1.9-18.9]) or insulin (AOR=23.8 [7.1-79.8]) compared to those who were following a diabetic diet.

Conclusions

This study highlighted a very high proportion of UD in diabetic Tunisian adults. A better involvement of primary care physicians in overall patient care, and improved availability of antidiabetic drugs for patients, are strongly recommended.

Key messages

Majority of Tunisian diabetic adults aged 20 years or older had an uncontrolled diabetes. Improving patient education and the availability of antidiabetic drugs for diabetic individuals in primary healthcare facilities is essential.

Anxiety and depression among individuals in mandatory institutional quarantine in Tunisia

Background

The COVID-19 pandemic is a challenging public health issue that have impacted people's health and livelihoods worldwide. Restrictive measures, such as quarantine, have been implemented in many countries in order to limit the spread of the virus. We aimed in this study to assess the impact of institutional mandatory quarantine on mental health in Tunisia and to determine factors associated with the occurrence of anxiety and or depression.

Methods

A cross sectional phone survey was conducted in Tunisia from April to November 2020 among people who were placed in mandatory institutional quarantine. Generalized anxiety disorder and depression were assessed using the Generalized anxiety disorder scale (GAD-7) and the Centre for Epidemiological Studies Depression Scale (CES-D-10). Bivariate and multivariate analyses were used to determine factors associated with the occurrence of depression and or anxiety symptoms.

Results

In the present study, 506 participants were enrolled with an age ranging from 18 to 83 years and a sex ratio equal to 1.9. More than third of participants (38.3%) had experienced anxiety and/or depressive symptoms. Being a woman, younger age, being a student, spending longer time on COVID-19 news, fear of infection in the quarantine facility, having experienced stigma, financial struggle due to the COVID-19 pandemic and dissatisfaction by the accommodations conditions of the quarantine facility were independently associated with occurrence of depression and or anxiety symptoms.

Conclusions

A high percentage of participants have experienced anxiety or depressive symptoms during the quarantine period. Providing mental health support and updated and relevant information to quarantined individuals is necessary. Improving the accommodation conditions in the quarantine facilities is also needed.

Key messages

More than third of participants had experienced anxiety and/or depressive symptoms. Good quality communication and mental health support are necessary in quarantine facilities.

Premature mortality attributable to tobacco smoking among Tunisian adults in 2016

Background

Tobacco smoking is a major risk factor for several debilitating health conditions, causing thus premature deaths and disability. Globally, 8 million deaths, mainly occurring in low and middle income countries, are attributable to tobacco use each year. We aimed in this study to estimate the premature mortality attributable to current cigarettes smoking among Tunisian adults aged 35-69 years.

Methods

The population attributable fraction (PAF) method was used to estimate the number of premature deaths attributable to smoking. The estimates for the total number of deaths in Tunisia in 2016 by causes were obtained from the health metrics database. The current cigarettes smoking prevalence was taken from a nationally representative household survey conducted in 2016 and the used relative risks were obtained from the cancer prevention study II of the American Cancer Society.

Results

A total of 3219 premature deaths were attributable to current cigarettes smoking accounting for 23.1% (34.2% in men and 2.1% in women) of the total number of deaths. The leading causes of premature mortality attributable to smoking were lung cancers (PAF= 79.6%), chronic obstructive pulmonary diseases (PAF= 54.5%) and upper aerodigestive tract cancers (PAF= 54.3%).

Conclusions

Nearly a quarter of premature deaths in Tunisia in 2016 were attributable to tobacco smoking. This underscores the need to enhance the MPOWER measures application mainly through the promotion of anti-tobacco awareness campaigns and the reimbursement of smoking cessation treatments.

Key messages

Tobacco smoking were responsible for a significant percentage of premature deaths mainly among Tunisian men in 2016. Our results highlight the urge to enhance the MPOWER measures application in Tunisia.

COVID-19 vaccine hesitancy among Tunisian cancer patients in the Salah Azaeiz Institute of Cancer

Background

Vaccination against SARS-CoV-2 is the most effective way to stop the pandemic and to avoid its related deaths. COVID-19 vaccine hesitancy, represent now a major hurdle to achieve herd immunity. Cancer patients constitute a prioritized group for COVID-19 vaccination as they are particularly vulnerable to severe infection and death. The aim of this study was to assess vaccine hesitancy among cancer patients of the Salah Azaiez Institute (SAI) of cancer and to identify its knowledge and attitudes associated factors.

Methods

A cross sectional study was conducted among all inpatients aged above 18 years old during the month of February 2021. Participants were asked according to a well-structured questionnaire about knowledge (vaccine literacy) and attitudes towards COVID-19 vaccine. Vaccine literacy was assed using two scales (functional and interactive-critical scales) for which a global score was calculated ranging from 1 to 4. A lower score corresponding to lower vaccine literacy. Chi square test and student's t test were used to identify knowledge and attitudes associated with COVID-19 vaccine hesitancy. A p value equal or less than 0.05 was considered statistically significant.

Results

Two hundred cancer patients were included with a mean age of 54.4±12.7 and a gender ratio equal to 0.5. Sixty-five percent reported that they would not receive the COVID-19 vaccine. Vaccine hesitancy was associated with lower interactive vaccine literacy score (1.6±0.8 vs 2.0, p = 0.002), skepticism regarding COVID-19 vaccine efficacy and safety (73.8% vs 38.5%, p < 0.001) and believing that health authorities will not be able to vaccinate the majority of the population (71,2% vs 55.7% p = 0.037).

Conclusions

The proportion of COVID-19 vaccine hesitancy among cancer patients is high. Mass media campaigns for vaccine promotion should be enhanced. Physicians and health care workers play a key role in increasing acceptance and uptake of COVID-19 vaccine among high risk patients.

Key messages

Majority of cancer patients were unwilling to receive the COVID-19 vaccine.

Patient education about the benefits of vaccination against SARS-CoV-2 should be an integral part of oncology visits.

Burden of non-communicable diseases in Tunisia, 1990-2017: results from the global burden of disease study

INTRODUCTION

non-communicable diseases (NCDs) are the leading cause of mortality and disability worldwide especially in developing countries such as Tunisia. We aimed to describe the national burden of non-communicable diseases in 2017 and to analyze disability-adjusted life year trends from 1990 to 2017 in Tunisia by cause and gender.

METHODS

we used Joinpoint regression analysis to assess trends of the age standardized disability-adjusted life year rate from 1990 to 2017 and to determine average annual percentage change.

RESULTS

non-communicable diseases accounted for 87.7% of total disability-adjusted life year in Tunisia in 2017. The five leading causes of this rate in Tunisia in 2017 were cardiovascular diseases, musculoskeletal disorders, neoplasms, mental disorders and neurological disorders. The trend of disability-adjusted life year rate of non-communicable diseases decreased significantly from 23403.2 per 100.000 (95% CI: 20830.2-26285.8) in 1990 to 18454.6 (95% CI: 15611.3-21555.4) in 2017, with a change of -0.9%; p=0.00. The decrease of the age standardized disability-adjusted life year rate concerned mainly cardiovascular diseases and neoplasms secondly. This decrease was more important in female (change=-1.1, p=0.00) in comparison to males (change=-0.7, p=0.00). On the other hand, the increase of the standardized disability-adjusted life year rate was related to musculoskeletal disorders, diabetes, kidney disorders and substance use disorders with a significant annual percentage change of 0.1%, 0.2% and 1.3% (p=0.00) respectively. Conclusion: the implementation of the national strategy is the key solution to mitigate the impact of non-communicable diseases in Tunisia.

[Efficacy of highly active antiretroviral therapy alone in the treatment of diffuse lymphocytic infiltration syndrome in an ivorian patient living with HIV: a case report]

Objective

We report in this work the efficacy of highly active antiretrovirals (ARVs) alone in the treatment of diffuse infiltrative lymphocytosis syndrome (DILS) without the use of corticosteroids, which appears risky in patients living with HIV.

Observation

This is a 60-year-old HIV-positive patient, discovered during the etiological workup of renal failure, which revealed a non-nephrotic glomerular profile. The renal biopsy found an interstitial infiltrate of CD8 suggestive of DILS. Management consisted in starting ARV treatment alone (lamuvidine, abacavir and raltegravir) without associated corticosteroid therapy. The clinical evolution under treatment was marked by a recovery of the renal function with a creatininemia at 99 μmol/l, a regression of the proteinuria, a CD4 rate at 293/mm³ and an HIV viral load at 533.3 copies or 1.6 log in the space of 3 months.

Conclusion

DILS is a diffuse systemic disease in HIV patients who are usually under poor virological control. In view of the strong immunosuppression and the absence of other infiltrative diseases, it appeared to us to be risky and unjustified to add a corticosteroid therapy.

Knowledge, attitudes and uptake related to influenza vaccine among healthcare workers during the 2018-2019 influenza season in Tunisia

BACKGROUND

The influenza vaccine (IV) is considered the most effective strategy to prevent seasonal influenza infection and annual vaccination of healthcare workers (HCWs) is recommended by the World Health Organization given their high mixing with patients. We assessed IV uptake among HCWs in the 2018-2019 season and explored their knowledge and attitudes regarding influenza immunization.

METHODS

A cross-sectional study was conducted in 150 representative Tunisian health facilities from March to May 2019. We recruited 1231 HCWs with direct patient contact using self-weighted multistage sampling. Univariate and multivariate logistic regression analyses permitted to assess the factors associated with IV uptake in the 2018-2019 influenza season.

RESULTS

Among 1231 health professionals enrolled in this study, less than half (36.6, 95% confidence interval [CI]: 33.9-39.4) received the IV at least once in their lives and only 15.3% (CI: 13.3-17.4) were vaccinated against influenza in the 2018-2019 influenza season. High confidence regarding IV efficacy, belief about the mandatory character of influenza vaccination for HCWs, and IV uptake in the 4 years preceding the 2018-2019 influenza season were independently associated with higher IV uptake by multivariate analysis. However, participants with high educational level were less likely to receive the IV than those with the lowest educational level.

CONCLUSIONS

Our study revealed a low vaccination rate among Tunisian HCWs confirming the importance of tailored education programs targeting this population.

Characteristics and prognostic factors of COVID-19 among infected cases: a nationwide Tunisian analysis

Background

The outbreak of coronavirus disease (COVID-19) continues to constitute an international public health concern. Few data are available on the duration and prognostic factors of the disease. We aimed to study the recovery time among a Tunisian cohort of COVID-19 confirmed patients and identify the prognostic factors.

Methods

A retrospective, nationwide study was conducted from March 2 to May 8, 2020, recruiting all patients who were diagnosed with COVID-19, by RT-PCR methods, in Tunisia. Data were collected via phone call interview. Kaplan-Meir Methods and Cox proportional hazards regression models were, respectively, used to study the recovery time and estimate its prognostic factors.

Results

One thousand and thirty patients with COVID-19 (aged 43.2 ± 18.2 years, 526 female (51.1%)) were enrolled. Among them 141 (14.8%) were healthcare professionals. Out of 173 patients (17.8%) admitted to the hospital, 47 were admitted in an intensive care unit. Among 827 patients who didn’t require specialized care, 55.5% were self-isolated at home, while the rest were in specialized centers. Six hundred and two patients were symptomatic. A total of 634 (61.6%) patients have recovered and 45 (4.4%) patients died. The median duration of illness was estimated to be 31 days (95% CI: [29–32]). Older age (HR = 0.66, CI:[0.46–0.96], P = 0.031) and symptoms (HR = 0.61, CI:[0.43–0.81], P = 0.021) were independently associated with a delay in recovery time. Being a healthcare professional (HR = 1.52, CI: [1.10–2.08], P = 0.011) and patients in home isolation compared to isolation centers (HR = 2.99, CI: [1.85–4.83], P < 10¯³) were independently associated with faster recovery time.

Conclusion

The duration of illness was estimated to be 1 month. However, this long estimated duration of illness may not equate to infectiousness. A particular attention must to be paid to elderly and symptomatic patients with closer monitoring.

Comparative expression profile of CD10 and cyclin D1 in cutaneous histiocytofibroma and dermatofibrosarcoma

Dermatofibrosarcoma protuberans (DFSP) and histiocytofibroma (HF) are two rare fibrohistiocytic tumors, with some overlapping pathologic features. Immunohistochemistry is very useful in these cases. CD34 is a commonly used marker. However, the increasing cases of CD34 negative DFSP make it pressing to test other immunohistochemical markers that could help in the differential diagnosis. DFSP is known to harbor COL1A1-PDGFB rearrangement. Tumors in the differential diagnosis of DFSP usually lack this molecular signature. Recent studies suggested the interaction of PDGFB and PDGF receptor b with various signaling pathways, including the Akt-mTOR pathway. Cyclin D1, one of the oncoproteins activated in this pathway, may represent a promising useful biomarker in the differential diagnosis. On the other hand, CD10 expression in specialized mesenchymal skin cells, and especially in fibrohistiocytic skin tumors has been reported, which raises the interest of using this biomarker in HF and DFSP. In this study, we aimed to compare the expression of CD10 and cyclin D1 in 15 cases of DFSP and 15 cases of HF and discuss their potential contribution in the differential diagnosis.

Estimating transmission dynamics and serial interval of the first wave of COVID-19 infections under different control measures: a statistical analysis in Tunisia from February 29 to May 5, 2020

BACKGROUND

Describing transmission dynamics of the outbreak and impact of intervention measures are critical to planning responses to future outbreaks and providing timely information to guide policy makers decision. We estimate serial interval (SI) and temporal reproduction number (Rt) of SARS-CoV-2 in Tunisia.

METHODS

We collected data of investigations and contact tracing between March 1, 2020 and May 5, 2020 as well as illness onset data during the period February 29-May 5, 2020 from National Observatory of New and Emerging Diseases of Tunisia. Maximum likelihood (ML) approach is used to estimate dynamics of Rt.

RESULTS

Four hundred ninety-one of infector-infectee pairs were involved, with 14.46% reported pre-symptomatic transmission. SI follows Gamma distribution with mean 5.30 days [95% Confidence Interval (CI) 4.66-5.95] and standard deviation 0.26 [95% CI 0.23-0.30]. Also, we estimated large changes in Rt in response to the combined lockdown interventions. The Rt moves from 3.18 [95% Credible Interval (CrI) 2.73-3.69] to 1.77 [95% CrI 1.49-2.08] with curfew prevention measure, and under the epidemic threshold (0.89 [95% CrI 0.84-0.94]) by national lockdown measure.

CONCLUSIONS

Overall, our findings highlight contribution of interventions to interrupt transmission of SARS-CoV-2 in Tunisia.

Health care renunciation in Tunisian diabetic patients, 2016

Background

Diabetes management requires access to health care, patient awareness about hygiene and diet measures, and patient adherence to prescribed treatment. Health care renunciation (HCR) can make diabetes management really challenging. We aimed to determine the prevalence of HCR in diabetic Tunisian patients and assess associated factors.

Methods

Data were obtained from the 2016 Tunisian Health Examination Survey, a household survey stratified at three degrees. For each household, two people aged 18 and over were randomly selected. Data were collected using: a household questionnaire and an individual questionnaire (risk behaviours and medical history). Diabetic patients were asked whether, they had renounced any health care service, the last time they needed to seek healthcare. Data analysis was performed with R software.

Results

A total of 880 diabetic patients were included in this survey, with a mean age of 61±12 years and a sex ratio M/F equal to 0.9. The prevalence of HCR was 4.9% (95% CI [3.3-6.5]), higher in men (7.4% VS 2.6% in women, p = 0.003) and higher in urban areas (5.4% VS 3.1 in rural areas, p = 0.09). After multivariate adjustment (taking into consideration age, gender, profession, health insurance and place of residence as independent variables), having no health insurance and being aged more than 50, were significantly associated to HCR, with adjusted Odds Ratios equal to (3.8, 95% CI [1.4-9.2]) and (3.4, 95% CI [1.9-10.1]), respectively.

Conclusions

Our study has highlighted a relatively low prevalence of HCR compared to literature data (4.9% VS 10-15%), explained mostly by methodological differences regarding HCR assessment. HCR in diabetic patients is mostly explained by economic reasons, which show how important is a better organisation of Tunisian public health system to ensure equity in access to health care.

Key messages

Health care renunciation in diabetic Tunisian patients is explained mainly by financial reasons (having no health insurance). Moving further towards improving universal health coverage is a key pillar in the proper management of chronic diseases such as diabetes.

Willingness of healthcare workers to recommend seasonal influenza vaccine to patients- Tunisia, 2019

Background

Most countries of the Eastern Mediterranean Region have low influenza vaccination coverage mainly among high risk groups. Advice to receive the influenza vaccine by healthcare workers (hcws) seems to be an important motivator for vaccine acceptance among patients. In this study, we aimed to describe the willingness of Tunisian hcws to recommend the seasonal influenza vaccine to patients and to assess its determinants.

Methods

A cross-sectional questionnaire-based study was conducted in Tunisian primary and secondary healthcare facilities during the 2018-2019 influenza season. A multivariate logistic regression was used to assess the factors associated with the willingness of hcws to recommend the influenza vaccine to patients.

Results

In the present study, 1231 hcws were included with a mean age of 44.5±9.3 and a sex ratio (Male/Female) equal to 0.25. Among respondents, more than three quarter (79.1%, 95% CI: [76.7-81.3]) declared their willingness to recommend the influenza vaccine to patients if available. In multivariate analysis, belief that influenza vaccine is a severe illness that may lead to death (adj.OR = 2.9, 95% CI: [1.9-4.1]) and previous influenza vaccine uptake among health professionals (adj.OR = 2.4, 95% CI: [1.5-3.9]) were independently associated with the willingness of hcws to recommend the flu vaccine to patients.

Conclusions

This study showed that hcws with a history of influenza immunization and those who were aware of influenza severity were more likely to be willing to recommend the influenza vaccine to patients. These findings should be considered in future educational programs to enhance hcws' recommendation of influenza vaccine.

Key messages

Majority of Tunisian healthcare workers declared their willingness to recommend the influenza vaccine to patients. Healthcare workers’ awareness of influenza severity and history of influenza vaccine uptake were associated with a higher willingness to recommend the flu vaccine.

Determinants of influenza vaccination intention among Tunisian elderly

Background

Influenza vaccination coverage among elderly remains unsatisfactory even in developed countries. Since attitudes are predictors of behavior, understanding factors influencing the intention to receive influenza vaccine (IV) among elderly may orientate interventions to increase vaccination rate. The aim of the current study was to identify factors associated to willingness to receive IV next season among Tunisian elderly.

Methods

During 2018 -2019 flu season a cross-sectional study was conducted among older persons aged 60 years and over with chronic disease attending primary and secondary health care facilities. The intention to get vaccinated against influenza was measured by means of a face to face questionnaire. Factors that affect willingness to receive IV were identified using a multiple logistic regression analysis.

Results

Of the 1191 older persons included, 19.4% [17.1-21.9] participants received IV in 2018-2019 flu season, 64.7% [61.9-67.3] expressed willingness to be vaccinated next season. Willingness to receive IV was more likely among persons with chronic pulmonary disease (ORa=2.6), those suffering from diabetes (ORa=1.6), those who received IV in 2018-2019 flu season (ORa=16.5), those who feel that they get enough information about vaccines and their safety (ORa=2.9) and persons who trust the advice of their health care providers (ORa=4.5).

Conclusions

Vaccination status was the most determinant factor associated to willingness to receive the vaccine. Therefore, sustainable efforts to promote IV may lead to cumulative increase of influenza vaccination coverage year by year. Doctors should be involved more in advocating IV and providing elderly with the necessary information about IV, but that could not be effective without a climate of trust between patients and health care providers.

Key messages

Positive self-experience of older persons with IV may change their perception about it and encourage them to adhere to the vaccine in the future. Elderly should be provided with the necessary information about IV in terms of effectiveness and safety.

Influenza immunization among Tunisian health care workers in the 2018-2019 influenza season

Background

Given the nature of their activities, health care workers (hcws) are at higher risk of contracting influenza and transmitting the disease to their patients. Influenza vaccine (IV) remains the most effective way to prevent influenza and its complications. To the best of our knowledge, no national data on IV coverage among hcws is available in Tunisia. The present study aimed to assess the flu vaccination coverage among Tunisian hcws in the 2018-2019 influenza season and factors associated with IV uptake through a study of knowledge and attitudes related to influenza vaccination.

Methods

A cross sectional study was conducted in Tunisian primary and secondary health care facilities from March to May 2019. Hcws with direct patient contact were recruited according to a self-weighted multistage sampling. Survey data collection was based on a face to face questionnaire containing both open and closed questions.

Results

A total of 1231 hcws were enrolled in this study. Among respondents, 15.3% (95% CI: [12.3-17.2]) were vaccinated against influenza during the 2018-2019 influenza season. High confidence regarding vaccine efficacy (OR = 3.5, 95%CI: 2.5-4.8), belief that hcws' influenza immunization may decrease illness and deaths among patients (OR = 1.7, 95% CI: 1.2-2.3) and belief that influenza vaccination can reduce work absenteeism (OR = 1.7, 95% CI: 1.2-2.4) were associated with a higher IV uptake among hcws. In addition, participants who mentioned hcws as a target group for influenza vaccination (OR = 2.0, 95% CI: 1.5-2.8) and who were agree that IV is indicated annually for hcws (OR = 3.1, 95% CI: 1.9-4.9) were more likely to receive the IV.

Conclusions

Influenza vaccination coverage among Tunisian health professionals in 2018-2019 was low. Our findings suggest that knowledge and attitudes regarding influenza vaccine influence vaccine compliance among hcws and should thus be targeted by vaccination campaigns to promote flu vaccine uptake in the health community.

Key messages

Vaccination coverage among Tunisian healthcare workers was low in the 2018-2019 influenza season. Our findings suggest that knowledge and attitudes regarding influenza vaccine influence vaccine uptake among Tunisian health care workers.

Prevalence, awareness and control of hypertension among Tunisian adults, 2016

Background

Hypertension is becoming increasingly frequent mainly in low and middle income countries. We aimed to assess the prevalence, awareness and control of hypertension among Tunisian adults and identify associated factors with hypertension control.

Methods

Data were obtained from the 2016 Tunisian Health Examination Survey, a household survey stratified at three degrees. Adults (age≥18 years old) were interviewed using an individual questionnaire, then three blood pressure measurement were performed. Participants were considered hypertensive if they were previously diagnosed or had a systolic blood pressure (SBP) ≥140mmhg and/or a diastolic blood pressure (DBP) ≥ 90mmhg during the survey. Were considered under control, treated persons with SBP&lt;140 mmhg and a DBP&lt;90 mmhg. A weighted binary logistic regression was used to assess associated factors with hypertension control. Input model variables were: sociodemographic variables, comorbidities and lifestyle factors.

Results

In this study, 8908 adults were enrolled with a mean age of 42.8±0.2 years old and a sex ratio (M/F) equal to 0.96. Among respondents, 29.3% (95% CI: 28.2-30.5) had hypertension, 60.7% (95% CI: 58.7-62.6) of them were unaware of their disease and only (29.5%, 95% CI: 28.2-30.5) of treated patients had a controlled hypertension. In multivariate analysis, eating more than five fruits and vegetables per day was independently associated with a better hypertension control (AOR=1.7, 95% CI: 1.1-2.5). In addition, participants living in northern Tunisia were more likely to have a controlled hypertension than those living in the south (AOR=1.9, 95% CI: 1.2-2.9).

Conclusions

Almost third of Tunisian adults were hypertensive. Low level of awareness and control of hypertension were found in this study. This highlights the urge to reinforce hypertension screening interventions and to strengthen educational programs on this disease with a focus on blood pressure monitoring and healthy lifestyle measures.

Key messages

Tunisian adults had a low level of awareness and control of hypertension. Reinforcing hypertension screening interventions and increasing awareness about healthy lifestyle measures are recommended.

Prevalence of seasonal Influenza vaccination among Tunisian elderly

Background

Surveys to determine the uptake of influenza vaccine (IV) among the at-risk groups are required to evaluate the advancement of national vaccination strategies and the level of awareness in the surveyed population. In this context, the present study aimed to estimate influenza vaccination uptake in elderly in Tunisia during 2018-2019 influenza season and to assess their perceptions toward influenza and IV.

Methods

It was a national cross-sectional study conducted in 2019 in primary and secondary health care facilities, among persons aged 60 years and over with chronic disease. Data were collected using a standard administered questionnaire including questions about IV uptake, general knowledge and attitudes about influenza and IV. Perceptions of participants toward general statements about influenza and IV were compared by vaccination status using chi square test.

Results

In total, 1191 older persons were included. Nearly one third of participants (34.8% [32.2-37.6]) were vaccinated at least once at the past and 19.4% [17.1-21.9] received the vaccine during 2018-2019 influenza season. Compared to unvaccinated elderly, vaccinated persons were significantly more convinced that influenza is more dangerous for elderly people (90.0% vs. 82.2%, p = 0.008), that IV is recommended for older persons (88.7% vs. 70.1%, p &lt; 0.001) and for those with chronic disease (86.1% vs. 64.1%, p &lt; 0.001) and that IV can protect elderly persons (87.9% vs. 71.9%, p &lt; 0.001) and those with chronic disease (88.3% vs. 66.3%, p &lt; 0.001). Regarding attitude about the safety of the vaccine, while 14.4% of unvaccinated persons agreed that IV is not safe for older persons, only 9.5% of vaccinated elderly approved that statement (p = 0.060).

Conclusions

Our study showed a low influenza vaccination rate among Tunisian elderly. In order to promote IV, campaigns should focus on educating elderly regarding the seriousness of influenza and the efficiency and the safety of IV.

Key messages

Efforts must be invested to improve influenza vaccination coverage among Tunisian elderly especially those with chronic diseases. Educating elderly regarding influenza and IV is necessary since knowledge is a basis for adopting relevant attitudes and practices.

Attitudes towards plagiarism among academics of the faculty of Medicine of Tunis

Assessing the extent of plagiarism within academics remains the first step in the fight against this behavior. The current study aimed to explore the attitudes of the Faculty of Medicine of Tunis (FMT)'s academics toward plagiarism. A cross-sectional study was conducted within the FMT during the 2018-2019 academic year. Data were collected using a questionnaire including the English version of the attitudes toward plagiarism questionnaire (ATPQ) which is composed of 29 statements divided into three attitudinal factors: positive, negative attitudes and subjective norms toward plagiarism. A total of 340 faculty members responded to the survey. The mean scores for both positive attitudes (28.8 ± 6.9) and subjective norms (24.6 ± 4.9) were between low to moderate and that of negative attitudes was moderate (22.4 ± 2.6). In multivariate analysis, participants with higher academic rank, those who had a good level of English or who attended English courses and those who attended workshops in scientific writing were less tolerant toward plagiarism. The implementation of courses on research practices as well as the introduction of medical English courses in the FMT's post graduate program could constitute relevant approaches to limit the extent of plagiarism.