Catheterized chicken for training on ultrasound-guided vascular access: A simple, cost-effective, and effective model

Ultrasound-guided vascular access is a medical procedure that is becoming increasingly common in daily practice and is recommended to avoid iatrogenic complications. One of the procedures with a high-risk rate of complications is the vascular puncture. However, training on this technique can be challenging due to the limited availability of simulation models. We propose a simple, cost-effective, and effective ultrasound-guided vascular access simulation model that utilizes chicken breast and a urine catheter to address this need.

Man-O-War simulator: a Low-cost manikin for training on chest tube management

Simulation-based medical education is becoming a cornerstone in health education. Simulators are commonly expensive and not available in developing countries. We propose a very low-cost simulator that any educator can realize. We describe here the steps to follow to develop this proposed simulator.

Les effets indésirables des équipements de protection chez les professionnels de santé

Contexte

Les professionnels de santé (PDS) étaient obligés de porter les équipements de protection individuels (EPI) au cours de leur exercice en pandémie, afin de minimiser le risque de transmission du virus émergent. L'objectif de cette étude était de quantifier la prévalence de survenue des effets indésirables (EI) relatifs au port des EPI chez les PDS et d’étudier les facteurs qui lui sont associés.

Méthodes

Il s'agissait d'une étude transversale ayant inclus un échantillon représentatif de 300 PDS randomisés dans le CHU Hedi Chaker de Sfax, Tunisie, durant la période août-septembre 2021. Le recueil des données était réalisé par un questionnaire auto-administré anonyme.

Résultats

Au total, 218 sujets étaient de sexe féminin (72,7 %), l’âge moyen était de25,6 ± 3,49 ans. Selon la profession, 202 cas étaient des médecins (67,3 %) et 26 sujets avaient une ancienneté ≥ 10 ans (8,7 %). Les EI relatifs au port des EPI étaient notés chez 87 PDS, soit une prévalence de 57,2 %. L'analyse multivariée a montré que les facteurs indépendamment associés aux liés au port d'EPI chez les PDS étaient le sexe féminin (Odds Ratio Ajusté (ORA)=1,8 ; p=0,048), avoir des maladies chroniques (ORA=0,29 ; p=0,001) et avoir une infection antérieure par la COVID-19 (ORA=0,46 ; p=0,004). L'utilisation fréquente d'eau de Javel ou autre produit de désinfection sans protection et l'utilisation d'eau chaude en milieu de travail étaient indépendamment associées à un risque élevé d'effets indésirables ((ORA=2,22 ; p=0,003) et (ORA=2,83 ; p=0,005), respectivement). De même, la durée d'utilisation des EPI > 4 heures par jour (ORA=1,98 ; p=0,039), ainsi que l'utilisation de visières et/ou de lunettes en milieu de soins (ORA=1,84 ; p=0,045) étaient statistiquement plus associés à la survenue de EI chez les PDS.

Discussion/Conclusion

La prévalence des EI relatifs au port des EPI était importante. Des multiples facteurs lui étaient associés notamment professionnels. Des formations adéquates et répétitives destinés aux PDS portant sur le bon usage des EPI demeurent indispensables pour gérer ce problème.

Déclaration de liens d'intérêts

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

Evidence of SARS-CoV-2 symptomatic reinfection in four healthcare professionals from the same hospital despite the presence of antibodies

OBJECTIVES

Since the onset of the COVID-19 pandemic, cases of reinfection with SARS-CoV-2 have been reported, raising additional public health concerns. SARS-CoV-2 reinfection was assessed in healthcare workers (HCWs) in Tunisia because they are at the greatest exposure to infection by different variants.

METHODS

We conducted whole-genome sequencing of the viral RNA from clinical specimens collected during the initial infection and the suspected reinfection from 4 HCWs, who were working at the Habib Bourguiba University Hospital (Sfax, Tunisia) and retested positive for SARS-CoV-2 through reverse transcriptase-polymerase chain reaction (RT-PCR) after recovery from a first infection. A total of 8 viral RNAs from the patients' respiratory specimens were obtained, which allowed us to characterize the differences between viral genomes from initial infection and positive retest. The serology status for total Ig, IgG, and IgM against SARS-CoV-2 was also determined and followed after the first infection.

RESULTS

We confirmed through whole-genome sequencing of the viral samples that all 4 cases experienced a reinfection event. The interval between the 2 infection events ranged between 45 and 141 days, and symptoms were milder in the second infection for 2 patients and more severe for the remaining 2 patients. Reinfection occurred in all 4 patients despite the presence of antibodies in 3 of them.

CONCLUSION

This study adds to the rapidly growing evidence of COVID-19 reinfection, where viral sequences were used to confirm infection by distinct isolates of SARS-CoV-2 in HCWs. These findings suggest that individuals who are exposed to different SARS-CoV-2 variants might not acquire sufficiently protective immunity through natural infection and emphasize the necessity of their vaccination and the regular follow-up of their immune status both in quantitative and qualitative terms.

Magnitude of general obesity, abdominal obesity and related risk factors among medical students

Introduction

Obesity is recognized to be one of the greatest public health problems worldwide. In addition to physical health problems, obesity is also linked to an increased risk of mental health disorders. We aimed to estimate the magnitude of overweight/obesity among medical students, to identify their risk factors and to assess their impact on mental health.

Methods

We conducted a cross-sectional questionnaire survey among 524 medical students randomized from different levels, at the Faculty of Medicine of Sfax, Tunisia, on October 2019.

Results

The prevalence of combined overweight/obesity and abdominal obesity were 21.9% and 22.3%, respectively. The independent risk factors of overweight/obesity were male gender (OR = 3.2; 95% confidence interval (CI) = [1.96-5.2]), internship (OR = 2; 95% CI = [1.1-3.9]) and residency (OR = 3.2; 95% CI = [1.7-6]) levels, as well as moderate (OR = 3.4; 95% CI = [1.4-8.3]) and high (OR = 6.7; 95% CI = [2.6-16.9]) stress scale. However, daily fresh vegetables (OR = 0.4, CI95% = [0.2-0.8]) and high-fiber cereals whole-grain bread (OR = 0.5; 95%CI = [0.28-0.83]) consumption, light (OR = 0.37; 95% CI = [0.16-0.86]), moderate (OR = 0.24; 95% CI = [0.06-0.89]) and vigorous exercise (OR = 0.091; 95% CI = [0.01-0.74]) were independent protective factors of overweight/obesity. Severe consequences of obesity were noted, such as less ability to concentrate (37.9% vs 47.6%; p = 0.024), living under stress (72.2% vs 60.6%; p = 0.023), feeling unhappy and depressed (57.4% vs 44.7% p = 0.016), losing confidence (45.2% vs 20.5%; p < 0.001) and inability to enjoy normal activities (53.9% vs 38.7% p = 0.03).

Conclusions

Unhealthy lifestyle was relatively high among students with obesity. Our study confirms the data from the literature, and underlines the need to set up a plans including nutrition and lifestyle education in their curriculum.

Key messages

Unhealthy lifestyle was relatively high among students. The need to set up a plans including nutrition and lifestyle education.

Non-communicable diseases in Southern Tunisia: morbidity, mortality profile and chronological trends

Introduction

Non-communicable diseases (NCDs) represent a major public health problem worldwide. Giving their impact on the morbidity and mortality burden, understanding their chronological trends over time is a priority for epidemiological surveillance. We aimed to determine the epidemiological specificities of NCDs and to study their chronological trends over the period 2010-2015.

Methods

We retrospectively collected data of hospitalized patients from the regional registry of morbidity and mortality in the Southern University Hospital of Tunisia during the period 2010-2015.

Results

We included 18081 patients with NCDs aged ≥ 25 years, with an annual number of 3013 cases/year. The median age of patients was 60 years(Interquartile range IQR = [43-80 years)]). There were 10288 males(57%), with a sex ratio (male/female)of 1.3. The distribution of NCDs was characterized by the predominance of cardiovascular disease(CVD)(10346 cases, 57.2%), then cancers(3034 cases; 16.8%),diabetes(2489 cases; 13.8%) and chronic respiratory tract diseases(2212 cases; 12.2%). Chronological trends analysis of NCDs showed that they remained globally stable between 2010 and 2015. The same result was applied to the group of cancers, chronic respiratory diseases and diabetes mellitus. However, there was a sharp rise for CVD between 2010 and 2015(ρ = 0.84; p = 0.036). The proportion of CVD increased significantly among men(ρ = 0.87; p = 0.019) and elderly(ρ = 0.88; p = 0.019). During the study period, 234 deaths were due to NCDs, with hospital mortality and lethality rates of 5.2/1000 hospitalizations and 1.29%, respectively. CVD were the main cause of deaths(60%). The hospital mortality rate of NCDs increased significantly from 2010 to 2015(ρ = 0.85; p = 0.031), notably for CVDs(ρ = 0.94; p = 0.005).

Conclusions

Chronological trends analysis revealed a significant rise in the morbidity and mortality burden ofCVDs during the period 2010-2015. It is imperative, therefore, to strengthen health care for these patients.

Key messages

Non-communicable diseases. Morbidity and mortality.

Chronological trends and causes of deaths among reproductive-age-women in Southern Tunisia

Introduction

Mortality data of women with reproductive age (WRA) data are important indicators of the health system performance. This study aimed to determine the magnitude, trends and main causes of WRA deaths.

Methods

The study used longitudinal hospital-based surveillance design for the period 2014-2020 in Southern Tunisia including all WRA (15- 49 years) who died in public health facilities in this region.

Results

During the 7-year-period, there were 331 WRA deaths, and this number increased sharply with age (χ2= 21.7;p<0.001). Non-communicable diseases were the leading causes of deaths (41.7%) and were statistically more frequent in older women (52% vs 37.5%;p<0.001) and urban regions (48.9% vs 36.6%;p=0.025). Concerning communicable diseases and maternal deaths, they were statistically more common in rural regions (12.4% vs 5%;p=0.026 and 17% vs 8.8%;p=0.031,respectively). There were 45 maternal deaths, with an average maternal mortality ratio (MMR) of 51.39/100,000 Live births(LB)/year. There was a slowly declining trend in the MMR during the reference period, without significant change (χ2=0.7;p=0.4), with a peak of 97.37/100,000LB in 2016. Direct obstetric deaths constituted 73.9% of all maternal deaths, among which the leading causes were obstetric haemorrhage (66.7%) and eclampsia (14.3%). Among the indirect causes, cardiovascular diseases (37.5%) and infections (16.6%) were the most common.

Conclusions

Mortality indicators among WRA remained sustainably high in Southern Tunisia, despite the declining curve. The causes of death varied according to age groups and access to health facility. Strengthening community-based initiatives to promote the goal of ending preventable maternal deaths is urgently recommended.

Key messages

High mortality indicators among WRA remained sustainably in Southern Tunisia. Stregthening community-based initiatives to promote the goal of ending preventable maternal deaths is urgently recommended.

Prevalence survey on antimicrobial use & multidrug resistance in tertiary level university hospital

Introduction

Excessive and inappropriate use of antibiotics is highly associated with the emergence of antibiotic resistance. Antibiotic resistance reduces the effectiveness and number of options for antibiotic treatment, leading to increased morbidity, mortality, and health care expenditures. This study aimed to characterize antimicrobial prescriptions and to determine multidrug resistance (MDR prevalence in tertiary-level university hospitals (TLUH).

Methods

It was a point-prevalence survey of antimicrobial use in the two TLUH of Southern Tunisia, in 2019. For inpatients receiving antimicrobials, detailed information was collected.

Results

Totally, 1047 inpatients were included in our study. The sex ratio (male/female) was 1.1. The mean age was 50 ± 12 years. Overall, 410 cases (39.2%) were on antimicrobials. A significant association was noted between receiving antimicrobial drugs and admission in intensive care units (ICU) (65.% vs 30.2%; p < 0.001), having a surgical history, notably minimal invasive (81.9% vs 30.7%; p < 0.001)and indwelling invasive medical devices such as urinary (17.6% vs 3.9%; p < 0.001). and central vascular catheters (8.6% vs 2.2%; p < 0.001). Main antimicrobials were penicillin (26.7%), fluoroquinolones (20%) and third-generation cephalosporins (16.5%). Prophylactic indication constituted 24.9% (102 cases) of prescriptions, among which 81.3% were judged inappropriate for dose or timing while health-care associated infections accounted for 46.4% of all prescriptions. Parenteral route was prescribed in 302 cases (73%). Antibiotic indications were documented 221 cases (53.9%). Of 78 isolates, 50% were multidrug resistant strains, among which the commonest pathogen was extending-spectrum-beta lactamase producing Escherichia Coli (10 cases,25.6%).

Conclusions

This study demonstrated a high prevalence of antimicrobial use and MDR which needs addressing especially for surgical prophylaxis and empirical broad-spectrum antimicrobial prescriptions.

Key messages

High prevalence of multidrug resistance. The needs to addressing especially for surgical prophylaxis and empirical broad-spectrum antimicrobial prescriptions.

Chronological trends of cardiovascular diseases in Southern Tunisia over a fourteen year -period

Introduction

Cardiovascular diseases are the leading cause of death worldwide and in Tunisia. In fact, as a result of progressive urbanization and westernization of lifestyle the spectrum and pattern of cardiovascular diseases CVD along with their risk factors are changing. The aim of this study was to describe the epidemiological profile of CVD hospitalizations, to evaluate their chronological trends and to estimate their future projected trends.

Methods

We retrospectively collected data from the regional morbidity registry of the University Hospital of Sfax, Tunisia, between 2003 and 2016. We included patients with ischemic heart disease (IHD), heart failure (HF) and rhythm and conduction disorder (RCD). Join-point regression analysis was performed to study chronological trends of CVD (Annual Percentage Change (APC); p).

Results

The mean age-standardized hospital incidence rate (ASHIR) was 94.8, 20.6 and 14/100000 inhabitants/year for IHD, HF and RCD, respectively. Trends analysis of CVD showed a significant increase in the ASHIR of IHD from 54.3/100000 inhabitants in 2003 to 123/100000 inhabitants in 2016, with an Annual Percentage Change (APC) of 3.59% (95% confidence interval (CI):0.4-6.7%; p < 0.001). An upward trend was observed for HF, with ASHIR rising from 8.6/100000 inhabitants in 2003 to 22.6/100000 inhabitants in 2016, with an APC of 8.29% (95%CI:4.1-12;p<0.001). For RCD, no significant change in ASHIR was found. Projections showed that the estimated ASHIR would attend 131 and 36.5/100000 inhabitants for IHD and HF, respectively, while RCD would decline to 19.6/100000 inhabitant in 2026.

Conclusions

IHD and HF were rising at an alarming rate and were expected to continue up to the next 10 years. Primary and primary prevention of cardiovascular risk factors, therapeutic education and early management would have a positive impact in the short and long term.

Key messages

The importance of the bidder of cardiovascular diseases. The necessity of primary prevention.

Frailty screening of Tunisian older adults: feasibility and usefulness in the Emergency Department

Introduction

Frail older adults are at an increased risk for adverse outcomes after an Emergency Department (ED) visit. Several tools exist for the screening of frailty among these patients. However, no tool has been validated in Tunisia. This study aims to evaluate the usefulness of frailty screening in predicting the outcome of older adults presenting to the ED.

Methods

This is a prospective, monocentric study. We evaluated the eligible patients at the ED and after their discharge. Follow-up phone calls were scheduled at 1, 2, 3, and 6 months after the ED visit. All patients aged 65 years or older; and visiting the ED during the inclusion period were involved. We used the ADL index and ISAR scale for assessing frailty.

Results

We enrolled 184 patients; they were living alone in 25% of cases. Half of them had medical care insurance. The ADL index was maximum (6 = total dependency) in 20% of cases. The ISAR score was above 1 point in 38%. Unplanned hospitalizations have accounted for 34%. In univariate analysis, the ADL index and ISAR score were statistically higher in the group of “unplanned hospitalization”. In multivariate analysis, the ISAR score and ADL index have not been associated with unplanned hospitalization.

Conclusion

Our results did not demonstrate the relevance of the ISAR or ADL scales in predicting the mortality or the need for unplanned hospitalization in multivariate analysis. This study did indicate an increased mortality in the “frail” patients in the univariate analysis. Further studies with larger samples and different tools are necessary.

[An exceptional cause of peritonitis: ileal perforation due to a foreign body during reduction of an inguinal hernia]

La péritonite secondaire est fréquemment rapportée dans la littérature. Les causes sont multiples. Nous rapportons un cas d'une perforation iléale par une cause exceptionnelle. Il s'agit d'une perforation iléale par un corps étranger lors de la réduction d'une hernie inguinale, responsable d'une péritonite grave avec tableau de défaillance multiviscérale.

[Active smoking: A major risk factor for human non-communicable diseases in a hospital survey]

INTRODUCTION

Tobacco is the main preventable cause of death worldwide. Our study aimed to determine the role of tobacco in the occurrence of non-communicable diseases (NCDs).

METHODS

We conducted a retrospective study including all NCDs patients during 2015-2016. NCDs include cardiovascular diseases (CVD), chronic respiratory diseases (CRD), cancers (CS) and diabetes mellitus (DM).

RESULTS

We identified 3643 cases of NCDs (43%) among 8478 hospitalizations, all diseases combined. Active smoking was found in 1076 cases (29.5%). Among the NCDs groups, CVD was the most common (65%). Tobacco was significantly associated with CVD (P<0.001), CRD (P=0.002), bronchopulmonary CS (P<0.001), haematological malignancy (P=0.023), and DM (P<0.001). Multivariate analysis performing binary logistic regression revealed that tobacco was an independent factor associated with CVD (OR=2.6, P<0.001), CRD (OR=1.5, P<0.001), bronchopulmonary CS (OR=1.8, P=0.013) and DM (OR=3.6, P<0.001).

CONCLUSION

Active smoking was a major risk factor in the occurrence of NCDs. Thus, smoking cessation represents the cornerstone for preventing the spread of these diseases, especially in countries with limited resources.

Value of troponin levels in the diagnosis of cardiac dysfunction in moderate scorpion envenomation

Context:

Cardiac dysfunction is one of the most serious consequences of scorpion envenomation. The best tool to evaluate cardiac function is echocardiography, but it is not available at all emergency departments. Many studies aimed to describe biological predictive factors of cardiac dysfunction in scorpion envenomation. Troponin is one of these biomarkers but its correlation with myocarditis is not well established. The aim of this study was to evaluate correlation between troponin levels and cardiac dysfunction in moderate scorpion envenomation.

Methods:

A retrospective monocentric study including patients admitted in the emergency department for moderate scorpion envenomation with troponin measurement during their early management. On arrival, an electrocardiogram and a chest X-ray were realized for all patients.

Results:

We enrolled 132 patients with a mean age at 31.3 ± 24.4 years and a 1.35 sex-ratio. All patients had moderate systemic manifestations. There were 28 patients with clinical manifestations of cardiac dysfunction without life-threatening troubles (21.2%). Troponin was undetectable in 69 patients (56%). The mean value of troponin level (pg/ml) was higher in patients with clinical manifestations of left ventricular dysfunction (1.80 ± 3.8 vs. 0.11 ± 0.5; p = 0.02). Troponin levels were significantly higher in patients with positive T wave on electrocardiogram.

Conclusion:

In patients with moderate scorpion envenomation with positive T wave, high values of troponin suggest the presence of cardiac dysfunction.

[Surgical and endoluminal management of the inflammatory aortitis: A Tunisian center experience]

Non-infectious aortitis is usually due to giant-cell arteritis, Takayasu disease or Behçet disease. The main aortic lesions are stenoses, occlusions and aneurysms in the Takayasu disease and aneurysms in the Behçet disease and giant-cell arteritis. Treatment is based on corticosteroid therapy and surgery. Endoluminal management is now the rule. We report a retrospective descriptive study of 10 patients who underwent surgical or endoluminal management of inflammatory lesions of the aorta between January 2000 and December 2015. There were 4 cases of Takayasu disease and 6 cases of Behçet disease. The aortic lesions were aneurysmal in all of the patients with Behçet disease. In the patients with Takayasu disease, aortic occlusions predominated, associated with other arterial lesions. Four patients with Behçet disease were managed surgically, and 2 patients underwent endovascular repair. All of the patients with Takayasu disease underwent surgery. Two patients died in the postoperative period, and two patients died during long-term follow-up. Systematic screening, as well as regular monitoring of the entire aorta during the follow-up, is necessary due to the frequency of aortic aneurysms.

Crystal structure of lithium ammonium hexachlorotellurate(IV), [Li0.2(NH4)0.8]2TeCl6

Cl6H6.4Li0.4N1.6Te, cubic, Fm3̅m (No. 225), a = 10.357(2) Å, V = 1111.0 Å3, Z = 4, Rgt(F) = 0.060, wRref(F2) = 0.149, T = 299 K.