Descriptive correlational study of knowledge, attitudes and practices related to blood exposure accidents among operating room nurses in the two university hospitals of Sousse

INTRODUCTION

The occupational infectious risk in the health care environment is potentially ubiquitous. Several infectious agents are transmitted to healthcare professionals, especially by blood and body fluids.

AIM

To describe the knowledge; attitudes and practices related to blood exposure accidents (BEA) among operating room nurses and to determine their associated factors.

METHODS

A descriptive correlational study was conducted from February 24 to April 10, 2022, among nurses of the operating rooms in the two university hospitals of Sousse using an auto administrated questionnaire inspired from the literature.

RESULTS

Our population was composed of 133 nurses. The average age was 38.79 ±7.75 years and the average length of work was 12.02 ±7.8 years. Overall, the respondents had moderate knowledge about BEA. Indeed, 17.3% did not know the meaning of the acronym BEA. Concerning the attitudes, almost (63.1%) had been the victim of at least one BEA. The most frequent types of BEA were pricks (81%), cuts (37%) and splashes (33.3%). The mechanisms of occurrence were mainly recapping (91.7%) and disposal of health care waste (74.4%). Only 48.1% of respondents had received training on BEA. The systematic use of gloves for health care procedures was unsatisfactory (66.2%). According to the studied practices, in case of injured skin, (82.7%) of the respondents wore gloves if they had any skin lesions. Almost all respondents (90.2%) were vaccinated against hepatitis B. Women had better knowledge about the meaning of the acronym BEA (p=0.011). The comparison of practices showed that recapping dirty needles after use was significantly higher among females than males (p=0.011).

CONCLUSION

The solid knowledge about the BEA and systematic application of standard precautions in health care settings must be concretely manifested in the daily practices of health professionals.

Connaissances et pratiques des étapes préalables à la stérilisation des dispositifs médicaux thermorésistants : Etude au Centre Hospitalo-Universitaire Sahloul, Sousse-Tunisie - 2022

OBJECTIVES

The standard process of central sterilization is crucial for the optimal functioning of the operating room. The outcome of this process is closely linked to the steps preceding the steps prior to the sterilization step itself. These steps include pre-disinfection carried out in the operating rooms and other stages, namely washing, drying and packaging, which must be performed in the central sterilization unit. In this context, this study aimed to describe the knowledge of the staff in the operating rooms and the central sterilization unit at Sahloul University Hospital in Sousse (Tunisia) in 2022, regarding the steps prior to the sterilization of reusable thermoresistant medical devices and to describe their practices in terms of compliance with these steps.

METHOD

A descriptive study was conducted from January 2022 to June 2022 with the aforementioned staff, using a self-administered questionnaire to assess their knowledge of the pre-sterilization steps and a direct observation audit of their practices with regard to these steps. Both measurement instruments were pre-tested.

RESULTS

Out of 102 self-administered questionnaires (knowledge assessment) distributed to the staff concerned, only 80 were returned and correctly filled out, giving a response rate of 78.4%. Participants' responses regarding the order of steps prior to the sterilization were incorrect in 64% of cases. With regard to the evaluation of professional practices, 224 observations were made in the study area (practice audit). In 82% of these observations, the pre-disinfection step was confused with the washing step. The use of Betadine brushes and scrubbing pads for device washing was noted in 89.3%, along with the absence of swabbing of the canals and hollow parts in 9.4% of cases and the absence of drying of the canals with compressed air.

CONCLUSION

Mastery of the steps prior to sterilisation of reusable thermoresistant medical devices was insufficient in our institution, suggesting the importance of reinforcing the implementation of the procedure through a continuous training program followed by action plans.

Therapeutic education of patients with coronary heart disease: Impact of digital platform monitoring in preventing major cardiovascular events in Tunisia: Study protocol

BACKGROUND

Faced with the increase in the number of chronic diseases with the aging of the population, and with the observation of the insufficiency of therapeutic control, a new need has emerged, that of having a patient as a partner in care.

METHODS

This study is a randomized controlled trial. Patients with coronary heart disease will be recruited from one clinical site and randomly assigned into two groups: the intervention group and the control group. All participants will be followed up for a total of one year (with three-time points for data collection). Patients who are assigned to the intervention group will receive therapeutic education at first. The digital platform will then allow healthcare providers to accompany them outside the hospital walls. The primary outcome is the incidence of major cardiovascular events within one year of discharge. Main secondary outcomes include changes in health behaviors, medication adherence, and quality of life score. The digital platform is a multi-professional telemonitoring platform that allows care teams to accompany the patient outside the hospital walls. It allows the collection and transmits information from the patient's home to the therapeutic education team. All data will be secured at a certified host. The patient application provides data on compliance, adherence to physical activity (number of steps taken per day), adequate diet (weight gain, food consumed during the meal, compliance with low-salt or salt-free diet, diabetic diet), smoking cessation, as well as medication adherence. Access to educational tools (digital media) is provided to all initial program participants. These tools will be updated annually by the rehabilitation team on the recommendations. The platform also offers the possibility of organizing an individual or group remote educational session (videoconference modules allowing group and individual sessions), a secure integrated caregiver-patient messaging system. The control group will receive the usual controls at the hospital.

DISCUSSION

To offer a complete solution of care to our patients, we have thought of setting up a digital platform that aims to monitor the patient and strengthen their abilities to manage their condition daily. This pilot experience could be generalized to several services and disciplines. It could be used in several research works.

TRIAL REGISTRATION

Trial registered with the Pan African Clinical Trial Registry (PACTR202307694422939). URL: https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=24247.

Prevalence and associated factors of unhealthy diet among adolescents: cross-sectional study among Tunisian high school students

OBJECTIVES

According to World Health Organization (WHO),Unhealthy Diet (UD)is a major risk factor for chronic diseases. That's why it is important to study the UD and its associated factors. Our study aimed to describe the dietary behavior of young high school students and determine associated factors of UD.

METHODS

A cross-sectional study was carried out among students of seven high schools in center-eastern Tunisia during the academic year 2021/2022. Data collection was carried out in April2022 by questionnaires. The questions concerned the socio-demographic characteristics, food habits and physical activity. WHO defined UD as the consumption of less than five fruits and vegetables per day. Data analysis was done using SPSS software.

RESULTS

A total of 740 adolescents were included. The mean age was17±1.16 years with extremes ranging from 14to19 years. Sex-ratio was 0.66. UD was found among 91.6 % of the study population. At multivariate analysis, eating cake (aOR=4.062; CI [1.685-9.795]; p=0.002),eating fried-food (aOR=3.239; CI [1.118-9.385]; p=0.03)and consuming sweets (aOR=3.263; CI [1.666-6.394]; p=0.001)were independent risk factors of UD. In the other hand, regular physical activity (aOR=0.524; CI [0.294-0.936]; p=0.029)and having breakfast regularly (aOR=0.523; CI [0.297-0.923]; p=0.025)were independent protective factors of UD.

CONCLUSIONS

The findings of this study showed an alarming prevalence of UD. Therefore, it is mandatory to establish effective strategies to support healthy diets and physical activity among adolescents in order to reduce non-communicable diseases related to UD.

Right-sided acute diverticulitis in a North African country: Presentation and management in one surgical center

PURPOSE

Right-sided diverticulitis is a rare entity in North Africa. Therefore, it is usually misdiagnosed, and the management of cecal diverticulitis is aggressive in most cases, whereas nowadays, most studies recommend a conservative approach with promising results. This study aims to describe the presentation, management, and outcomes of right-sided diverticulitis (RSD) and to present the experience of one surgical center in Tunisia.

METHODS

This is a retrospective study including all patients presented with RSD, in the Department of Surgery "A" of the Charles Nicolle Hospital between 2007 and 2021.

RESULTS

Forty patients were included in our study. The mean age was 42 years with a standard deviation of 14. The sex ratio was 1.1. Only 2 patients had chronic constipation. All patients presented right-sided abdominal pain, and only 3 patients had diarrhea. Twenty one patients were diagnosed during surgery. Fourteen patients were treated successfully by conservative management. An operative procedure was performed in 26 cases: 21 had a diverticulectomy (80%), two had an ileal resection (8%), and three had a right colectomy (11.5%). No postoperative events occurred with a short hospital stay (5 ± 3 days). Follow-up showed no recurrences.

CONCLUSION

Right-sided diverticulitis has a lower incidence and complication rate compared to left-sided diverticulitis. Conservative treatment has demonstrated favorable outcomes in managing RSD, although the available evidence remains limited.

A Simple Score for Predicting Paroxysmal Atrial Fibrillation in Patients with Embolic Stroke of Undetermined Source in a Tunisian Cohort Study

BACKGROUND

The annualized recurrent stroke rate in patients with Embolic Stroke of Undetermined Source (ESUS) under antiplatelet therapy is around 4.5%. Only a fraction of these patients will develop atrial fibrillation (FA), to which a stroke can be attributed retrospectively. The challenge is to identify patients at risk of occult AF during follow-up.

OBJECTIVE

This work aims to determine clinical factors and electrocardiographic and ultrasound parameters that can predict occult AF in patients with ESUS and build a simple predictive score applicable worldwide.

METHODS

This is a single-center, registry-based retrospective study conducted at the stroke unit of Sahloul University Hospital, Sousse, Tunisia, between January 2016 and December 2020. Consecutive patients meeting ESUS criteria were monitored for a minimum of one year, with a standardized follow-up consisting of outpatient visits, including ECG every three months and a new 24-hour Holter monitoring in case of palpitations. We performed multivariate stepwise regression to identify predictors of new paroxysmal AF among initial clinical, electrocardiographic (ECG and 24-hour Holter monitoring) and echocardiographic parameters. The coefficient of each independent covariate of the fitted multivariable model was used to generate an integerbased point-scoring system.

RESULTS

Three hundred patients met the criteria for ESUS. Among them, 42 (14%) patients showed at least one episode of paroxysmal AF during a median follow-up of two years. In univariate analysis, age, gender, coronary artery disease, history of ischemic stroke, higher NIHSS at admission and lower NIHSS at discharge, abnormal P-wave axis, prolonged P-wave duration, premature atrial contractions (PAC) frequency of more than 500/24 hours, and left atrial (LA) mean area of more than 20 cm2 were associated with the risk of occurrence of paroxysmal AF. We proposed an AF predictive score based on (1.771 x NIHSS score at admission) + (10.015 x P-wave dispersion; coded 1 if yes and 0 if no) + (9.841x PAC class; coded 1 if ≥500 and 0 if no) + (9.828x LA class surface; coded 1 if ≥20 and 0 if no) + (0.548xNIHSS score at discharge) + 0.004. A score of ≥33 had a sensitivity of 76% and a specificity of 93%.

CONCLUSION

In this cohort of patients with ESUS, NIHSS at both admission and discharge, Pwave dispersion, PAC≥500/24h on a 24-hour Holter monitoring, and LA surface area≥20 cm2 provide a simple AF predictive score with very reasonable sensitivity and specificity and is applicable almost worldwide. An external validation of this score is ongoing.

Enhancing proficiency in ascites puncture through procedural simulation: an audit type study investigating medium-term skill retention

INTRODUCTION

Medical simulation has become an essential teaching method for all health professionals. It not only allows to acquire technical and non-technical knowledge, but also helps the maintenance of acquired knowledge in the medium and long term. Ascites puncture is part of the basic technical procedures learned by medical students during their internship.

OBJECTIVES

To evaluate the role of simulation-based learning of ascites puncture on the improvement of theoretical knowledge and maintenance of skills at 3 months.

METHODS

We conducted an audit type study with two cycles of data collection at the simulation center at the Faculty of Medicine of Sousse between November 2020 and June 2021. We included learners in their third year of medical studies who had a hospital internship in the gastroenterology department at Sahloul Hospital in Sousse. All learners attended the initial simulation session on ascites fluid puncture. Thereafter, they were free to accept or refuse participation in the evaluation session that was scheduled after 3 months, depending on their availability.

RESULTS

Forty learners participated in the procedural simulation of the ascites fluid puncture technique. Thirty-four (85%) were female and six (5%) were male. In our study, we showed that following procedural simulation training of ascites puncture, there was a significant improvement in the theoretical knowledge of the learners (p < 0.000). Objective assessment of technical skills after 3 months showed the benefit of performance maintenance (p < 0.000).

CONCLUSION

Our study confirmed the benefit of simulation-based learning on the improvement of theoretical knowledge and the maintenance of technical performance in the medium term.

Health and Environmental Impact of Hospital Wastes: Systematic Review

<b><i>Introduction:</i></b> Healthcare activities are generally associated with the production of healthcare waste, a large part of which is assimilated to household waste (packaging, kitchen waste, green waste, etc.) and another category of waste which may have a risk to health and the environment given its nature and typology. This category of waste at risk includes waste at risk of infection such as stinging, sharp waste (needles, blade, scalpel, etc.), and waste at chemical risk. Poor management of hospital waste is a problem in most countries and especially in developing countries. We aimed to determine the health and environmental impacts of the poor management of healthcare waste. <b><i>Methods:</i></b> We carried out a systematic review of the French and English literature on the scientific research sites Medline/PubMed and Embase. This research was carried out over 3 months (April–June 2020). The search strategy was used by combining keywords and Boolean operators: Health, Health impact assessment, Hospitals, Medical waste, Waste disposal facilities, Environment, Environment/Epidemiology, Hospital waste, impact, workplace, Environment hazards, Healthcare works, Waste management. <b><i>Results:</i></b> It has been clear that the current management of healthcare waste is not capable of adequately preserving human health and environmental contamination from infection. The surveys analyzed showed that if incineration is properly treated, it would be an appropriate treatment method to deal with healthcare waste. However, exposure to pollutants produced by the incineration is still a public health problem. If incineration is seen as a practical solution for dealing with healthcare waste, low-temperature incinerators should be banned and replaced by modern incinerators equipped with air pollution control units. These problems are typical for any developing country which does not have the means to purchase incinerators which are more protective for the environment and equipped with the latest technologies. <b><i>Conclusions:</i></b> Thus, autoclaving and microwaves are considered better alternatives for treating healthcare waste. However, these methods are generally not adequate for the disposal of pathological, radioactive, laboratory, and chemotherapy wastes. Therefore, the specific management of healthcare waste is a major concern due to the potentially high risks for human health and the environment.

Control of Acinetobacter baumannii outbreak in intensive care units in Tunisia, 2022

Introduction

Acinetobacter baumannii is an emerging pathogen that is increasingly resistant to antibiotics and is mainly responsible for pneumopathy in fragile patients. This germ is frequently responsible for epidemics in hospitals. We aimed to describe the steps of the investigation of an outbreak of Acinetobacter baumannii affected our hospital, the measures implemented and the follow-up of the actions.

Methods

Following alerts issued by the microbiology department concerning 5 swabs detecting Acinetobacter of the same strain and the same antibiotic resistance profile in 3 different departments of intensive-care units (ICU), a team of the prevention and healthcare security department went onsite for an investigation in the hospital.

Results

We identified five cases with identical strains of multi-resistant Acinétobacter. The field visit allowed to identify some deficiencies in professional practices. All the patients were hospitalized in ICU (medical and surgical). The synoptic table showed that there was an overlap of hospitalization periods.A crisis cell was set up to validate, coordinate and implement control measures in accordance with CTINILS recommendations. Indeed, we proceeded to a technical isolation of the cases in their hospitalization sector, reinforced the basic hygiene and bio-cleaning measures and sensitized the medical and paramedical. Given that the three ICU departments shared the same medical staff during night shifts, the assumption that the germ was carried by the caregivers was the most likely hypothesis. We proceeded with a swab of the elements of the environment in the services concerned. Results showed that Acinetobacter was found on the nursing cart (visibly clean). A training about bio-cleaning and hygiene standard precautions is programmed.

Conclusions

Continuous surveillance, continuous hygiene trainings, combined with a rapid reaction capacity in case of identification of a new case, is essential to control the spread of nosocomial germs.

Key messages

• Multidrug-resistant Acinetobacter baumannii (MRAB) is an emerging cause of intensive care unit (ICU) outbreaks.

• Enhanced infection control measures limited the outbreak.

Prospective prediction of alcohol consumption among a Tunisian sample of adolescents

Background

During adolescence, alcohol consumption represents a new experience with the advantage of facilitating the integration of a peer group. The global overall prevalence of this risk behavior among the 15-19 years old was over 25% in 2018. However, this prevalence varies between countries.

Objectives

To determine the incidence and the predictors of alcohol consumption among high school students in Sousse, Tunisia between 2017/2018 and 2018/2019.

Methods

A prospective longitudinal study was conducted in four high schools in the governorate of Sousse during the 2018-2019 school year. Pre-trained medical doctors used an anonymous self-administered questionnaire to collect data about socio-demographic and educational features, alcohol consumption, tobacco use, illicit substances use and emotional disorders.

Results

Participants accounted for 404. Their average age was 16.4 (±1.1) years. Females represented 68%. The prevalence of alcohol consumption in 2017/2018 was 5.9% while the cumulative incidence during the 2018/2019 school year was 3.5%. Among males, this incidence was of 11.9%. Among females, it was of 3% (p = 0.020). Illicit substance use among friends was the main predictor of becoming alcohol consumer with an adjusted odds ratio of 6.4 (95% CI: 1.9-21.3) on the other hand, having an anxiety trouble predicted less this risk behavior (adjusted odds ratio =0.2 95% CI: 0.1-0.8).

Conclusions

Alcohol consumption is becoming more and more common among the adolescents of Sousse especially among males. The current national strategy against substances use in schools should be reinforced. Implementation of a social skills training among adolescents to improve assertiveness is essential.

Key messages

• Alcohol consumption has an upword trend among the adolescents of Sousse.

• The current prevention programs targetting adolescents in Tunisia should be revised and integrate a comprehensive and multisectoral program.

Time trends in Surgical Site Infection rates in a Tunisian university hospital

Background

Surgical site infections (SSIs) are the most common hospital-acquired infections (HAIs) in low- and middle-income countries. Many reports have shown that surveillance and management of factors associated with SSI decreased rates and improved overall outcomes.This study aimed to appraise the prevalence trend and risk factirs of SSIs during 10-year period (2012 - 2021) in a Tunisian university hospital.

Methods

The SSI surveillance module is based on the National Healthcare Safety Network (NHSN), Centers for Disease Control and Prevention (CDC). For the current study, data collected over ten years through point prevalence surveys were analyzed. Univariate and multivariate logistic analysis were used to identify SSI risk factors.

Results

Overall, 2957 patients were observed; the mean age was 48.4 ± 23.5 years and 57.2% were male. We identified 289 infected patients (9.8%) and 319 HAIs (10.8%). SSIs were found in 21.6% of cases.The prevalence of SSI decreased from 27.9% in 2012 to 21.6% in 2021. However, this decrease was not statistically significant. The majority of the positive cultures were Staphylococcus aureus (14.3%) followed by Escherichia Coli (11.1%) and Klebsiella pneumoniae (9.5%). Antimicrobial resistance was found in 17.5% of cases. Univariable analysis found that lenght of stay (p &lt; 10-3), obesity (p = 0.047), the use of antibiotic treatment in 6 months (p = 0.002), and the use of central line (p &lt; 10-3) were associated with SSI. Independent risk factors significantly associated with SSIs were length of stay (aOR=8.6), the use of central line (aOR=3), and the use of antibiotic treatment in 6 months (aOR=2.2).

Conclusions

With continuous surveillance, the prevalence of SSIs decreased. In Sahloul university hospital, there has been a strengthening of the application of hygiene standard precautions during the two last years, and more particularly the respect of hand hygiene, combined with continued inpatient antimicrobial stewardship programs.

Key messages

• Active surveillance and management of factors associated with surgical site infection (SSI) decreased the incidence and improved overall outcomes.

• With continuous surveillance, the prevalence of SSIs decreased over the 10-year study period.

Association between lifestyle choices and mental health among medical students during the COVID-19 pandemic: A cross-sectional study

INTRODUCTION

Mental health is recognized as a critical component of public health Given the close relationship between mental health and life style and the importance of students as valuable human resources, the present study aimed at determining the relationship between life style and mental health among medical students in Sousse during COVID-19 pandemic.

METHODS

We conducted a cross-sectional observational study in university students from the first to the fifth grade of the Faculty of Medicine of Sousse during the academic year 2020/2021. Data were collected anonymously via an online questionnaire published on the Facebook groups of each grade, on december 2020. The online survey consisted of three sections. The first one aimed to collect sociodemographic information. The second section of the survey addressed recent lifestyle choices and the third one assessed psychological distress using the French version of 12 items of The General Health Questionnaire (GHQ-12). The significance level was considered 0.05.

RESULTS

Overall 147 were studied. Using the bimodal scoring, the total score was between 0 and 12, to evoke psychiatric disorders, we set the threshold of 4. For our sample, the median scale was 7 [4-9], and more than half of the students (68%; n = 100) had a score higher than 4. Psychiatric disorder was significantly more frequent in female students (73.3% vs 42.3%; p = 0.002). Higher GHQ-scale was found in younger students, foreigners, students who need more than 30 minutes to get to the faculty, unemployed students, and students of fifth grade. However, differences were not statistically significant. Regarding lifestyle choices, we found that physical inactivity, no smoking habits, no alcohol use, no illicit substance use, other substance use, changing in eating habits, and absence of coping methods of stress were higher in students with psychiatric disorders. However, this association was statistically significant only for physical activity (p = 0.016). The results of the regression analysis suggest female gender as an independent predictor of high GHQ-12 scores. Practicing physical activity was found as protective factor for psychiatric disorders.

CONCLUSION

Considering the vital role of medical students in providing and promoting community health, the need for more detailed planning and interventions to improve their life style and mental health is essential.

[Therapeutic education in patients with coronary artery disease: impact on smoking cessation]

AIM OF THE STUDY

To describe the results of a therapeutic education program (cessation rate and success factors) among smoking coronary patients followed in the smoking cessation clinic at Sahloul University Hospital in Sousse during the period from 2015 to 2020.

PATIENTS AND METHODS

A descriptive cross-sectional study was conducted among smokers with coronary artery disease who presented to the smoking cessation clinic at Sahloul University Hospital during the period from 2015 to 2020. The data collection was done by reviewing the records of smokers. We defined cessation as complete and continuous abstinence at 1 week, at 3 months, at 6 months and at 12 months and more. The study of cessation success factors involved subjects whose cessation was maintained for 1 year or more.

RESULTS

Among 93 patients with coronary artery disease, the prevalences of smoking cessation rates were 54.8% (n = 51), 44.1% (n = 41), 35.5% (n = 33), 31.2% (n = 29), and 24.7% (n = 23) at 1 week, 1 month, 3 months, 6 months, and 12 months respectively. In univariate analysis, the number of visits greater than or equal to three (p = 0.000) and nicotine treatment (p = 0.018) were significantly associated with successful smoking cessation at 12 months. In multivariate analysis, being non-active (p = 0.028) with a Fagerstrom score <7 (p = 0.040) and three or more visits (p = 0.005) were the independent factors associated with successful smoking cessation at 12 months.

CONCLUSION

The evaluation of the smoking cessation axis of therapeutic education of the coronary patient with tobacco addiction at the Sahloul University Hospital, allowed us to note that the cessation rate is comparable or even higher than that of other studies. However, the rate of maintenance of this cessation at 1 year and more proved to be low despite the strong motivation of the consultants. This observation allows us to better orientate the areas of improvement in the management of our consultants.

Educational effectiveness of simulation in teaching health science students Smoking cessation: A Systematic Review

BACKGROUND

Simulation is one of the educational tools that can be used in the learning process to help with smoking cessation.

AIM

To synthesize all the publications studying the contribution of simulation as an educational tool in the acquisition of skills to help with smoking cessation.

METHODS

We performed a systematic review of the Francophone and Anglophone literature over the past 24 years (1997 to 2020) using the PubMed, Science Direct and Cochrane Library databases.

RESULTS

A total of 14 articles were included. The most used methods were thestandardized patient, role play and video projection with discussion. The simulation hasnot only proved its effectiveness in terms of acquiring knowledge and self-confidencein the management of the smoking patient in the short term, but also in the acquisition of verbal and non-verbal skills in the long term.

CONCLUSION

This review highlighted the interest of simulation as an educational tool to acquire skills to help with smoking cessation regardless of the method used.

Radical versus conservative surgical treatment of liver hydatid cysts: A paired comparison analysis

BACKGROUND

The management of liver hydatid cysts (LHC) is complex and includes surgery, percutaneous drainage, chemotherapy and observation. Broadly, there are two types of surgical treatment for LHC - conservative surgery (CS) and radical surgery (RS). The purpose of this study was to compare the outcome of RS and CS.

METHODS

Data from all patients with LHC treated in Sahloul Hospital, between January 2000 and December 2019, were retrieved. To minimize selection bias, paired comparison analysis (PCA) was performed.

RESULTS

A total of 914 patients were included in this study. RS and CS were performed in 284 and 630 patients, respectively. After PCA, 206 patients were included in each group. The incidence of intraoperative bleeding was significantly higher in the RS group. The overall morbidity was significantly lower in the RS group. Thity-four patients developed recurrence with significantly higher recurrence in CS group.

CONCLUSION

RS is associated with fewer postoperative complications and lower recurrence rate compared to CS. RS may be the preferred procedure for LHC if the expertise is available.

The burden of Alzheimer’s caregivers and social support in the Tunisian family

Background

Alzheimer is a pathology that concers the patient and his family having a physical, social, economic and psychological impact. Research on family caregivers is still lacking and little is known about caregivers burden and ist associated factors in Tunisia. The aim of this study were to describe caregiver burden among Tunisian family caregivers of patients with alzheimeŕs disease, its associated factors and ist relationship to social support.

Methods

We conducted a cross-sectional study among 118 family caregivers during three months at the neurology outpatient departments of two university hospitals. Sahloul, Sousse and Taher Sfar, Mahdia. Using the Zarit Burden Interview-22 (ZBI)items and the Medical Outcome Study-Social Support Survey to assess burden and social support among the caregivers.

Results

We included 118 caregivers of patients with Alzheimeŕs disease,with an average age of 45±15 years. Women were more predominant with a sex ratio of 0.57.Half of caregivers were the descent of patients. The Mean years of caregiving was 5±3 years with an average of 13 hours ±3 of care assistance per day. The mean ZBI Score was 38.4±18.5 and 16.1% of caregivers percived a severe burden. The mean ZBI Score was higher in female, retired, lowmsocio economic status and in rural area with a statistically significance difference. We found that caregiver burden and social support were highly correlated (p &lt; 0.001,r=-0.41)indicating that a high level of caregiver burden was asoociated with a less level of social support.

Conclusions

The level of burden in family caregivers who are caring for a patient with alzheimeŕs disease is high. A considerate help and support from helth care and social institutions is required by taking into account the factors that contribute to caregivers burden and considering the importance of social support in alleviating caregiver burden.

Key messages

The level of burden in family caregivers who are caring for a patient with alzheimeŕs disease is high. High level of caregiver burden was asoociated with a less level of social support.

Evidence-based practice among health students: attitudes, knowledge, skills and perceived barriers

Introduction

Evidence-based practice (EBP) is a worldwide approach in optimizing quality of healthcare. As healthcare providers are increasingly more involved in clinical decision making, it is becoming important for them to use the best evidence to make effective and justifiable decisions. EBP is an important competency of undergraduate healthcare students that remains little known among Tunisian future healthcare professionals. This study aimed to describe health sciences students' attitudes. Knowledge and skills in EBP; to determine factors associated with these competencies and to identify perceived barriers regarding EBP.

Materials and Methods

A descriptive cross-sectional study was conducted at the Higher School of Health Sciences and Techniques of Sousse among 365 health sciences students enrolled during the second semester of the academic year 2017-2018. Data was collected using a self administrated questionnaire including a validated EBP-COQ questionnaire and focusing on identifying the perceived barriers to the usage of EBP.

Results

The response rate was 93.11%. Approximately, 61.6% of students were familiar with the term ‘EBP'. The overall score of EBP-COQ questionnaire was 3.26 ±0.53 out of 5. The mean scores of attitude, skills and knowledge subscales were 4.04 ±0.41; 3.05 ±0.77 and 2.70 ±0.74 respectively. A significant statistical association was found between the competencies in EBP and age; gender, academic degree, year of study for license degree, students' English-language reading skills, students' education in research methodology and statistics (p &lt; 10-3). The top reported barriers hindering their adoption of EBP were: lack of training in EBP, difficulty in obtaining full-text papers and lack of time.

Conclusions

The strategic position of healthcare students may influence the adoption of EBP. It is necessary to understand students' attitudes, knowledge and skills in the subject to be able to develop effective strategies for EBP curricula.

Key messages

Evidence-based practice is a worldwide approach in optimizing quality of healthcare. It is necessary to understand students' attitudes, knowledge and skills to develop effective learning strategies.

Social support and health-related quality of life among patients with chronic heart failure

Introduction

Heart failure (HF) represents a major public health issue in Tunisia due to its frequency and its consequences in terms of morbidity and mortality. Despite improved treatment, HF is still associated with high mortality and impaired quality of life. Therefore, improvement or maintenance of health-related quality of life (HRQoL) is important when caring for these patients. The aim of this study was to evaluate the health-related quality of life (HRQoL) and explore its associated factors and its relationship with social support.

Material and methods

A cross sectional study was conducted over a period of two months in the cardiology departments in the following university hospitals: Sahloul and Farhat Hached in Sousse, Fattouma Bourguiba in Monastir and Taher Sfar in Mandia. Overall, 92 participants were included. Data was collected using an interview administrated questionnaire in the Tunisian dialect. This questionnaire used the Tunisian version of the SF-36 and MSPSS.

Results

The mean age of the participants was 63.1 ± 10.4 with female predominance (53.3%). The overall score of the SF-36 was 45.1 ± 26.5. The physical component was more impaired than the mental component ((41.2 ± 29.1 VS51.3 ± 27). The two dimensions mental health and social functioning had obtained the highest averages (63.6 ± 22.4 and 51.4 ± 33.1; respectively). The MSPSS score was 52.5 ± 21. The ‘family' subscale had the highest mean (21 ± 8). HRQoL was positively associated with social support (p = 0.013; r = 0.257). The predictors of good HRQoL were: young age, university level of education, cohabitation with family, high socioeconomic level and one-sided HF.

Conclusions

Therapeutic education sessions should be implemented in order to improve the functional symptoms of HF, reduce the rate of readmissions and subsequently improve HRQOL. We also stress the importance of giving priority to strengthening social ties between the patient and their social circles.

Key messages

Heart failure is still associated with high mortality and impaired quality of life. Therapeutic education sessions should be implemented in order to improve the Quality of life of HF patients.

Quality of life in adult patients with open-angle glaucoma:a systematic review

Background

Assessment of the quality of life of glaucoma is an essential basis for their management in order to prevent deterioration of the disease. The aim of the study was to describe through a systematic review the quality of life of patients with open angle glaucoma and identify its associated factors.

Methods

It was a systematic review conducted based on the preferred reporting items for Systematic Reviews and Meta-analyses (PRISMA).Criteria for eligibility were all published population-based primary literature in Pubmed and Embase interface, written in English, since January 2014 to 31 December 2019. Electronic research was done through the following documentary query ((((‘glaucoma'[MeSH Terms]) AND (‘quality of life'[MeSH Terms])) AND (‘open angle glaucoma'[Title/Abstract])) AND (‘adult'[MeSH Terms])) AND (‘risk factors'[MeSH Terms]).Level of evidence and grades of recommendation was assessed according to the Scottish Intercollegiate Guidelines Network (SIGN).

Results

Among 139 articles, 15 were selected. Most of them were descriptive cross-sectional studies using different measuring instruments. We found that the quality of life of glaucoma patients varies according to the regions in Asia, Europe, America and Africa. The highest scores were recorded in Asia, followed by North America and Europe, which have very close scores. The risk factors associated with the quality of life of glaucoma patients were: Age, sex, level of education, professional status, marital status, visual acuity and disability, anxiety and depression.

Conclusions

The level of quality of life in this type of patient varies considerably between regions and countries and even in the same country. Associated factors are predominantly socio-demographic.

Key messages

The level of quality of life in patients with glaucoma varies considerably between regions and countries. Associated factors are predominantly socio-demographic.

Trends of Healthcare-associated Infections in a Tuinisian University Hospital and Impact of COVID-19 Pandemic

BACKGROUND

Although efforts to manage coronavirus disease 2019 (COVID-19) pandemic have understandably taken immediate priority, the impacts on traditional healthcare-associated infection (HAI) surveillance and prevention efforts remain concerning.

AIM

To describe trends in HAIs in a Tunisian university hospital through repeated point prevalence surveys over 9 years, assess the impact of measures implemented for COVID-19 pandemic, and to identify associated factors of HAI.

METHODS

The current study focused on data collected from annual point prevalence surveys conducted from 2012 to 2020. All types of HAIs as defined by the Centers for Disease Control and Prevention (CDC) were included. Data collection was carried out using NosoTun plug. Univariate and multivariate logistic analysis were used to identify HAI risk factors.

RESULTS

Overall, 2729 patients were observed in the 9 surveys; the mean age was 48.3 ± 23.3 years and 57.5% were male. We identified 267 infected patients (9.8%) and 296 HAIs (10.8%). Pneumonia/lower respiratory tract infections were the most frequent HAI (24%), followed by urinary tract infection (20.9%).The prevalence of infected patients increased from 10.6% in 2012 to 14.9% in 2020. However, this increase was not statistically significant. The prevalence of HAIs increased significantly from 12.3% to 15.5% (P =.003). The only decrease involved is bloodstream infections (from 2% to 1%). Independent risk factors significantly associated with HAI were undergoing surgical intervention (aOR = 1.7), the use of antibiotic treatment in previous 6 months (aOR = 1.8), peripheral line (aOR=2), parenteral nutrition (aOR=2.4), urinary tract within 7 days (aOR=2.4), central line (aOR = 6.3), and prosthesis (aOR = 12.8), length of stay (aOR = 3), and the year of the survey. Young age was found as protective factor (aOR = .98).

CONCLUSION

Contrary to what was expected, we noticed an increase in the HAIs rates despite the preventive measures put in place to control the COVID-19 pandemic. This was partly explained by the vulnerability of hospitalized patients during this period.

Prevalence and Characteristics of Undiagnosed COPD in Adults 40 Years and Older - Reports from the Tunisian Population-Based Burden of Obstructive Lung Disease Study

This study aimed to investigate the underdiagnosis of COPD and its determinants based on the Tunisian Burden of Obstructive Lung Disease study. We collected information on respiratory history symptoms and risk factors for COPD. Post-bronchodilator (Post-BD) FEV1/FVC < the lower limit of normal (LLN) was used to define COPD. Undiagnosed COPD was considered when participants had post-BD FEV1/FVC < LLN but were not given a diagnosis of emphysema, chronic bronchitis or COPD. 730 adults aged ⩾40 years selected from the general population were interviewed, 661 completed spirometry, 35 (5.3%) had COPD and 28 (80%) were undiagnosed with the highest prevalence in women (100%). When compared with patients with an established COPD diagnosis, undiagnosed subjects had a lower education level, milder airway obstruction (Post-BD FEV1 z-score -2.2 vs. -3.7, p < 0.001), fewer occurrence of wheezing (42.9% vs. 100%, p = 0.009), less previous lung function test (3.6% vs. 42.8%, p = 0.019) and less visits to the physician (32.1% vs. 85.7%, p = 0.020) in the past year. Multivaried analysis showed that the probability of COPD underdiagnosis was higher in subjects who had mild to moderate COPD and in those who did not visit a clinician and did not perform a spirometry in the last year. Collectively, our results highlight the need to improve the diagnosis of COPD in Tunisia. Wider use of spirometry should reduce the incidence of undiagnosed COPD. Spirometry should also predominately be performed not only in elderly male smokers but also in younger women in whom the prevalence of underdiagnosis is the highest.

[Adverse events in a Tunisian university hospital: incidence and risk factors]

OBJECTIVE

To determine the incidence and risk factors of adverse events (AE) in a Tunisian university hospital.

METHOD

We carried out a longitudinal observational study in 2016 over a period of 3&#160;months in the Sahloul university hospital of Sousse, Tunisia. Data were collected using a pretested form filled by doctors previously trained in the collection methodology, upon each visit to all hospitalized patients.

RESULTS

Overall, 1,357&#160;patients were eligible. We identified 168&#160;AEs in 131&#160;patients with AEs incidence of 12.4% (95% CI: [7.41 &#8211; 17.38]), and patient incidence of 9.7% (95% CI: [4.63 &#8211; 14.76]). The incidence density of AEs was 1.8&#160;events per 100&#160;days of hospitalization. Hospital acquired infection and unplanned readmission related to previous healthcare management were the most common AEs (43.4 and 12.5% respectively). Multivariate analysis revealed as independent factors of AEs: surgery (P&#160;= 0.013; RR&#160;=&#160;1.68; CI: [1.11-2.54]), the use of central-venous-catheter (P&#160;&lt;&#160;10&#8211;3; RR&#160;=&#160;4.1&#160;; CI: [2.1-8]), tracheotomy (P&#160;=&#160;0.001; RR&#160;=&#160;21.8; CI: [3.7-127.8]), transfusion (P&#160;= 0.014; RR&#160;=&#160;2.1; CI: [1.16-3.87]) and drug intake (P&#160;= 0.04; RR&#160;=&#160;2.2; CI:&#160;[1.04-4.7]).

CONCLUSION

The present study showed a high incidence of AEs and the involvement of invasive devices in their occurrence. Thus, targeted interventions are needed.

Characteristics of smoking behavior in adolescents, Sousse, Tunisia

Background and aims

Adolescence is a period of physical, psychological and socio-cultural transformation, but also of curiosity, experimentation and acquisition. It is mainly during adolescence that people are introduced to the use of legitimate psychoactive substances, such as alcohol and tobacco, as well as illicit substances such as cannabis. We aimed to determine the prevalence of smoking among high school students in the region of Sousse and to specify its characteristics.

Methods

We conducted a cross-sectional study in two public schools in the governorate of Sousse during the 2017/2018 school year. The data were collected by anonymous self-administered questionnaire, then processed and analyzed using the SPSS software version 20.

Results

A total of 294 students were included. The sex ratio was 0.78 with mean age of 17.03 years (standard deviation = 1.51). Results showed that 27.6% of students reported having already tasted tobacco. Among them, 61.8% of their parents did not know they were smoking. 17.28% started before the age of 14. Only 26% of them tried to stop but failed. Boys smoked twice as much as girls (p = 0.001). In addition, 63% of young smokers used chicha, 48.1% drank alcohol, and 35.8% used cannabis at least once.

Conclusions

The prevalence of smoking among these adolescents is worrying. Knowledge of related factors is important for program planning to prevent the tobacco epidemic in schools.

Key messages

Adolescence is the age of initiation for addictive substance use specially, Tobacco use. Knowledge of related factors is important for prevention program planning.

Risk factors of illicit substance use among Tunisian adolescents of Sousse

Background and aims

Adolescence is a period of physical, psychological and socio-cultural transformation, but also of curiosity, experimentation and acquisition. It is mainly during adolescence that people are introduced to the use of legitimate psychoactive substances, such as alcohol and tobacco, as well as illicit substances such as cannabis. Studying its predictors could help deal with this problem more efficiently. We aimed to determine the prevalence of life time illicit substance use and its predictors among Tunisian adolescents.

Methods

We conducted a cross-sectional study in two public schools in the governorate of Sousse during the 2017/2018 school year. The data were collected by anonymous self-administered questionnaire, then processed and analyzed using the SPSS software version 20.

Results

A total of 294 students were included. The mean age was of 17.03 years (standard deviation = 1.51). Females represented 56.1% of participants (sex ratio was 0.78). Among respondents: 60 (20.4%) had used illicit substance at least once. Cannabis was the main substance used by 35 (58.3%) students. The average age of the illicit substance use initiation was 16.3 (±1.1) years while it was 15.7 (±1.5) and 14.7 (±1.8) years for alcohol and tobacco use initiation respectively. Proportions of male students and academic failure were significantly more important among illicit substance users than among non users. While the most influential factors on illicit substance use were: alcohol use, and tobacco use (p &lt; 10-3). However, no significant association was found between illicit substance use and video games and internet use.

Conclusions

This study highlights the strong association between the other risk behaviors and illicit drug use. Future interventions should focus on the whole risk behaviors simultaneously at late adolescence with regard to the environmental context.

Key messages

Our results highlight the need to better understand behaviors at risk in Tunisia and the perceptions of prevention policies among students. Mainly during adolescence that people are introduced to the use of illicit substances.

Implementation of Adverse event surveillance system in a Tunisian tertiary care hospital (2018-2019)

Background

We found a high incidence of Adverse Events (AEs) following a survey conducted at Sahloul Hospital. Therefore, a surveillance system of AEs was implemented as a part of the implementation of the quality and risk management approach at Sahloul hospital, since April 2018. The aim of this study was to describe results of this system between May 2018 and April 2019.

Methods

It is a descriptive longitudinal study conducted at the Sahloul Hospital for a period of one year from May 1st, 2018 to April 30, 2019. Each service is provided with a data sheet that allows staff to report each adverse event they have witnessed. This does not include AEs that are part of alertness, blood exposure accidents or occupational accidents, or nosocomial infections which are assessed by specific circuits already in place.

Results

During the follow-up period, 93 AEs were reported. These AEs predominate in the sterilization unit followed by medical resuscitation and nephrology department with respective rates of 17.2%, 12.9% and 11.8%. The most frequent AEs were for maintenance (21.5%), medical device disinfection (20.5%), material resources (16.1%), and human resources (8.6%). According to criticality, the majority of AEs are tolerable under control (41.9%), unacceptable in 33.3% of cases and acceptable in 24.7% of cases.

Conclusions

In order to ensure proper functioning of the AEs surveillance and reporting system, the awareness of health professionals and their training would be essential. Quality of the information to be reported represents a challenge to be met to enable the planning, implementation and evaluation of improvement actions. Experience feedback would be with considerable benefit to improve the quality of professional practices.

Key messages

Surveillance and reporting system data analysis allow to identify mecanisms of the occurence of adverse events. Experience feedback is with considerable benefit to improve the quality of professional practices.

Addictive behavior in adolescents in Kairouan (Tunisia)

Background and aims

The levels of use of some psychoactive substances, especially alcohol, tobacco and cannabis, remain high among adolescents, despite progress in regulatory efforts to limit access to these products. Our objective is to determine the prevalence of addictive behavior among middle school students in the Kairouan region and to specify the risk factors.

Methods

We conducted a cross-sectional study in public schools of Kairouan (Tunisia) during one month (May 2016). Students aged 13 to 16 were included in the study. The statistical analysis was performed using the SPSS software version 18.

Results

A total of 2020 students participated in this study with mean age of 13.9 ± 1.2 years. A male predominance was noted (44.1%, n = 890). The prevalence of addictive behavior was 7.1% (95% CI = [6% - 8.2%]). Multivariate analysis showed that the probability of addictive behavior decreased in young women (OR = 0.05, 95% CI = [0.02 - 0.09]) from rural origin (OR = 0.51, 95% CI = [0.32 - 0.83]). Independent risk factors associated with addictive behavior were: Age (OR = 1.39, 95% CI = [1.16 - 1.66]), family history of suicide (OR = 4.42, 95% CI = [ 2.56 - 7.62]), repeating the school year (OR = 2.91, 95% CI = [1.84 - 4.60]), physical aggression (OR = 1.78; 95% CI = [1.06 - 2.98]) and depression (OR = 1.56, 95% CI = [1 - 2.43]).

Conclusions

The entourage and caregivers are important actors to help adolescent to verbalize his suffering and find other ways to fight against the depressive affects.

Key messages

Prevalence of psychoactive substance use is very high in middle school students. Identification of risk factors is important for prevention program planning at an early stage.

Results of screening for emergent highly resistant bacteria in Tunisian intensive care units

Background

The infections caused by emergent highly resistant bacteria (eHBR) that develop in intensive care units (ICUs) may result in significant patient illnesses and deaths, extend the duration of hospital stays and generate added costs. Facing this problem, the screening that emphasizes early identification of colonized patients, reduces the prevalence and incidence of infection, improves patient outcomes and reduces healthcare costs. In this context, we have implemented a screening for eHBR in ICUs of Sahloul university hospital of Sousse (Tunisia), which we report in this study the first six-months outcomes.

Methods

Rectal swab cultures were collected to detect Vancomycin resistant enterococcus (VRE) and Carbapenemase producing Enterobacteriaceae (CPE) among patients admitted in six ICUs of Sahloul university hospital of Sousse (Tunisia) and more than three times, at least one week apart, between 1 June and 31 December 2018.

Results

During the study period 174 patients were screened. Of them, 69.5% were male and 73.6% were admitted in surgical ICU. In total, 161 and 152 samples were realized respectively for the detection of CPE and VRE. These samples were positive in 15% and 8.5% respectively for CPE and VRE. Klebsiella pneumoniae OXA 48 was the most isolated CPE (80%).

Conclusions

Our screening program helped us in infection control by early identification of patients, thereby facilitating an informed decision about infection prevention interventions. Moreover, these results encouraged us to improve and generalize this program throughout the hospital.

Key messages

eHRB screening becomes an important axis in the prevention of eHRB infections in our facilities. eHRB screening allows the reinforcement of the basic infection prevention and control measures.

Trend of healthcare-associated infections in a teaching hospital in Tunisia, 2014-2019

Background

National surveys on the prevalence of HAIs on a given day have regularly taken place in health facilities. During this period, actions to improve HAI prevention were implemented, including strengthened isolation measures; hand hygiene promotion using the World Health Organization multimodal strategy; and promotion of appropriate antimicrobial use. We aimed to examine trends in HAI in Sahloul Hospital over six years.

Methods

Annual prevalence surveys of healthcare-associated infections (HAIs) between 2014 and 2019 were conducted in the university hospital in Tunisia. It is a cross-sectional study of one-day prevalence with a single pathway. All departments were included in the survey, except emergency and hemodialysis services due to their very short length of stay. Data collection was carried out using NosoTun plug (national HAI prevalence survey).

Results

Over six years, prevalence of HAI ranged from 11.4% in 2014 to 9.5% in 2019. The prevalence of HAIs did not show a significant change across the six surveys. However, there were significant (P = 0.008) reductions in the prevalence of total HAIs in intensive care units, which had the highest frequencies of HAIs over those six years. In 2014, bacteriological analysis was performed in 55.8% of HAI cases. In 66.6% of cases (n = 16), isolated bacteria were gram negative bacilli, the most frequent were Pseudomonas aeroginosa. In 2019, 27 germs were identified, the most frequent were Gram Negative Bacilli (74%), mostly Escherichia coli.

Conclusions

This HAI prevention strategy was influential in decreasing infections among hospitalized patients in intensive care units. Challenges for the future are to minimize infection with gram-negative bacilli while limiting the emergence of antibiotic resistant organisms.

Key messages

Using prevalence surveys, we were able to have an insight into the most common isolates identified throughout the last six years. Repeated prevalence surveys are an effective tool for monitoring HAI frequency and contributing to the establishment of effective infection control.

Multimodal Imaging in Retinitis Pigmentosa: Correlations among Microvascular Changes, Macular Function and Retinal Structure

Purpose:

To analyze microvascular changes in patients with retinitis pigmentosa (RP) with relatively preserved visual acuity (VA), using swept source optical coherence tomography (SS-OCT) angiography to correlate results to macular function and structure.

Methods:

This was a case–control study conducted over 70 eyes of 35 RP patients with relatively preserved VA. All patients underwent a complete ophthalmic examination, including SS-OCT, OCT angiography (OCT-A), fundus autofluorescence (FAF), and multifocal electroretinogram (mfERG). Thirty-four eyes of 34 healthy controls of age-, sex-, and axial length-matched (control group), were also analyzed. The main outcome measures were foveal and parafoveal vascular densities (FVDs and PFVDs) in the superficial capillary plexus (SCP) and deep capillary plexus (DCP), foveal avascular zone (FAZ) and its enlargement coefficient and their correlation with macular function (by means of VA and mfERG), and structure (by means of FAF and SS-OCT).

Results:

In the RP group, PFVD was 25.99 ± 5.2% in the SCP and 34.47 ± 2.37% in the DCP and were significantly lower as compared to control group (P < 0.0001; P = 0.0026, respectively). Enlargement coefficient of FAZ was 1.78 ± 0.79. We found a statistically significant correlation between VA and PFVD in the DCP (P < 0.0001), FAZ disruption in the SCP (P = 0.006) and enlargement coefficient of FAZ (P = 0.01). The parafoveal DCP density was significantly correlated with P1 amplitude (P = 0.005) in rings 2, 3, 4, and 5 of the mfERG. We found a statistically significant correlation between parafoveal density in the DCP, thickness of ganglion cell complex (GCC) (P = 0.001), and the width of ellipsoid band (P = 0.041). Parafoveal SCP density was also correlated to GCC (P = 0.033).

Conclusions:

We showed that vascular alteration in RP begins at the level of the DCP, which affects the outer retina and leads to a narrowing of the ellipsoid. The alteration of the SCP would occur later in the evolution of the disease. Vascular changes occur early during RP and were highly correlated to retinal function and structure. OCT-A seems to be a good tool to quantify vascular network loss and could play a central role in staging, prognosis, and monitoring disease progression.

Posterior staphylomas in non-highly myopic eyes with retinitis pigmentosa

PURPOSE

Our aim was to highlight the presence and the frequency of posterior staphyloma (PS) in non-highly myopic retinitis pigmentosa (RP) patients and to study the relationship between PS and choroidal thickness (CT).

METHODS

This was a retrospective case-control study of 77 eyes (39 patients) with RP, axial length inferior to 26 mm and clinically preserved macular area. All patients underwent fundus photography, A- and B-scan ocular ultrasonography, fundus autofluorescence (FAF) and swept source optical coherence tomography (SS-OCT). PS was defined by an outward bowing of the sclera on SS-OCT and B-scans. The relationship between the PS and SS-OCT layers thicknesses was determined.

RESULTS

Over 77 RP eyes of 39 patients studied, a PS was identified in 17 eyes (22%) of nine patients. Fifteen eyes had a narrow macular staphyloma (NMS), and two eyes had a wide macular staphyloma (WMS). Mean age in this group was 34.2 years (range 19-53 years), mean axial length was 23.60 ± 0.61 mm and mean CT was 185.7 ± 71 um versus 259.7 um in eyes without PS. The staphyloma edges corresponded to area of outer retina loss on SS-OCT and were larger than the hyperautofluorescent ring on FAF. We found a significant association between PS and CT in our RP patients (p = 0.003). The mean CT was significantly thinner in PS eyes compared to eyes without staphyloma. There was no significant association between PS and with visual acuity, years of progression, retinal thickness nor FAF findings.

CONCLUSIONS

PS was present in 22% of non-highly myopic eyes with RP. Narrow macular staphyloma was the most common type observed in our series. A marked thinning of the choroid was noted in PS eyes when compared to RP eyes without PS, as well as the outer retina degeneration.

Multimodal intervention program to improve hand hygiene compliance: effectiveness and challenges

BACKGROUND

Hand hygiene (HH) is considered the most important measure to tackle the transmission of healthcare-associated pathogens. However, compliance with recommendations is usually low and effective improvement strategies are needed. We aimed to assess the effectiveness of an intervention targeting hand hygiene promotion among healthcare workers (HCWs).

METHODS

We conducted a pre-post interventional study design in the university hospital Sahloul, Sousse, Tunisia, from January 2015 to December 2016. The intervention program consisted of training sessions and distribution of posters of hand hygiene guidelines. To assess the evolution of HH observance at pre- and post-intervention, the same observation form was distributed and collected at healthcare workers' workplace.

RESULTS

Of the 1201 and 1057 opportunities for hand hygiene observed among all categories of HCWs, overall compliance enhanced significantly from 32.1 to 39.4% (p < 0.001) respectively at pre- and post-intervention. Nurses were the most compliant with a significant improvement from 34.1 to 45.7% (p < 0.001) respectively at pre- and post-intervention. Furthermore, analysis by department showed significant improvement of compliance in orthopedic department (p < 0.001), maxillofacial-surgery department (p < 0.001), pediatrics department (p = 0.013), and emergencies (p = 0.038).

CONCLUSION

This study showed the feasibility and effectiveness of a health-setting-based intervention to enhance hand hygiene observance in the context of a developing country.

Intervention on knowledge and perception of hand hygiene among healthcare workers

Background

Many studies conducted in healthcare settings with limited resources reported healthcare associated infections (HAIs) rates higher than in developed countries. Hand hygiene is considered as the most effective procedure for reducing infection in a wide variety of settings. The aim of this study was to assess the effectiveness of an intervention program to improve knowledge and perception of hand hygiene among healthcare workers (HCWs).

Methods

We conducted a prospective before-and-after study design in university hospital Sahloul, Sousse, Tunisia, from January 2015 to December 2016. The same questionnaire, constructed by the WHO was distributed and collected at HCWs’ workplace.

Results

A total of 149 and 146 HCWs were enrolled, respectively at pre and post intervention. The majority was nursed women aged between 20 and 35 in pre intervention, whereas in post intervention the majority where physicians. Globally, our results showed tendencies toward improvement, but only two items were significant: the HW is the appropriate technique after injury (73.5% vs 86.8%; p = 0.006) and the hands of HCWs are the lead vehicle of HAIs (65.1% vs 83.6%; p = 0.01). On the other hand, judging by the HCWs’ responses, the probably most effective intervention to enhance hand hygiene compliance was that an alcohol-based hand-rub is available at each point of patient care. In contrast, empowering patients to remind HCWs to perform hand hygiene was mostly rated to be the least effective intervention both in pre and post intervention.

Conclusions

Our intervention to positively influence hand hygiene knowledge was unfortunately less effective than we had hoped it would be, which suggests a HCWs’ reluctance to attend the training program.

Key messages

Hand hygiene is considered as the most effective procedure for reducing nosocomial infection. the intervention to positively influence hand hygiene knowledge was effective.

Surveillance of healthcare-associated infections in a Tunisian university hospital

Introduction

Healthcare -associated infections has become a worldwide public health problem. The aim of this study was to estimate the incidence of healthcare- associated infections in a university hospital of Tunisia.

Methods

This was a cohort study conducted in six intensive care units in a university hospital of Tunisia during three months (from august to October 2018). Data was provided from patients’ files. Data entry and analysis was done using SPSS version 22. Multivariate analysis was used in order to identify independent risk factors for healthcare associated infection.

Results

A total of 202 patients were enrolled in this study. The incidence rate of healthcare-associated infections was 53,96%(109/202). The ratio infection/infected was estimated to 1.65(109/66).

The incidence of multi-drug resistant pathogens was 21,28% (43/202). The most common resistant pathogens included pseudomonas aeruginosa resistant to cefdazidime in 13,76%(15/109) followed by those resistant to extended spectrum cephalosporin 11.92% (13/109), followed by carbapenem-resistant acinetobcater baumanii 6,42%(7/109) then by carbapenem resistant pathogens and enterococcus resistant to vancomycin 2.75%(3/109) and finally staphylococcus aureus resistant to methicillin 2.1%(2/1.83). The multivariate analysis showed that long duration of central line catheterisation (RR = 7.44; 95%CI[2.79-19.82]), tracheotomy(RR = 8.61;95%CI[2.09-35,39]) and length of stay (RR = 1.08; 95%CI[1.04-1.13]) were found as independent risk factors for healthcare -associated infection.

Conclusions

The emergence of mutli-drug resistant pathogens needs to be deeply studied and effective measures have to be taken in order to detect and prevent transmission of resistant strains and/or their resistance determinants, especially those with phenotypes having the fewest viable treatment options.

Key messages

The incidence of healthcare associated infection in the intensive care unit was high. Effective measures have to be taken in the intensive care unit to detect and prevent transmission of resistant pathogens.

Evolution of Healthcare-associated infections over five years: results of prevalence surveys

Background

Tunisia is not spared from the scourge of healthcare associated infections (HAIs). National surveys on the prevalence of HAIs on a given day have regularly taken place in health facilities. We aimed to describe bacteriological profile as well as treatment modalities of HAIs in Sahloul Hospital for the last five years.

Methods

We conduct every year a prevalence survey, as part of the program for the prevention and control of HAI at Sahloul Hospital. It is a cross-sectional study of one-day prevalence with a single pathway. All departments were included in the survey, except emergency and hemodialysis services due to their very short length of stay. Data collection was carried out using NosoTun plug (national HAI prevalence survey).

Results

Over five years, prevalence of HAI ranged from 11.4% in 2014 to 7.1% in 2018. In 2014, bacteriological analysis was performed in 55.8% of HAI cases. In 66.6% of cases (n = 16), isolated bacteria were gram negative bacilli, the most frequent were Pseudomonas aeroginosa. In 2015, 17 germs were identified, and in 88.2% of cases (n = 5), isolated pathogens were also gram-negative bacilli, the most frequent were Pseudomonas aeroginosa (n = 4) and Acinetoobacter baumanii (n = 3). Besides, cephalosporin 3rd generation was the most frequent antibiotic used for the treatment. However, in 2016, Klebsiella Pneumoniae was the most frequent germ isolated. Among those infected patients, 26 were treated (92.8%). In 2017, 26 germs were identified, the most frequent were Gram Negative Bacilli (53.8%), mostly Escherichia coli and Pseudomonas aerginosa, followed by Acinetobacter baumanii. in 2018, 16 germs were identified, the most frequent were Gram Negative Bacilli (55.5%), mostly Klebsiella Pneumoniae.

Conclusions

The challenges for the future are to minimize infection with gram-negative bacilli while limiting the emergence of antibiotic resistant organisms.

Key messages

Our study helped us to have an insight into the most common isolates identified throughout the last five years. An incidence survey was carried out to better highlight the impact of healthcare associated infections in our hospital.

Risk factors of healthcare associated infections: prevalence surveys over five years

Background

Healthcare associated infection (HAI) is alarmingly increasing in low income settings. In Tunisia, the burden of HAI is still not well described. We aimed to analyze risk factors independently associated with HAIs in hospitalized patients in Sahloul Hospital for the last five years.

Methods

We conduct every year a prevalence survey, as part of the program for the prevention and control of HAI at Sahloul Hospital. It is a cross-sectional study of one-day prevalence with a single pathway. All departments were included in the survey, except emergency and hemodialysis services due to their very short length of stay. Data collection was carried out using NosoTun plug (national HAI prevalence survey). Logistic regression was performed to identify independent risk factors of mortality among infected patients with p value less than .05.

Results

Over five years, prevalence of HAI ranged from 11.4% in 2014 to 7.1% in 2018. In 2014, independent risk factors of HAIs were the use of peripheral venous catheter, central venous catheter, and undergoing a surgery. Intensive care units and surgical departments were independently associated with the occurrence of HAIs. In 2015 and 2016, in addition to the factors already mentioned, antibiotic therapies for the last six months as well as parenteral feeding were also found as independent risk factors. In both 2017 and 2018, intrinsic factors were found in multivariate analysis; in fact diabetes as underlying disease was independently associated with HAIs.

Conclusions

Identifying risk factors that contribute to develop HAIs may support the implementation of strategies for their prevention, therefore maximizing patient safety.

Key messages

Identifying risk factors for HAIs may improve patient safety. Insertion of medical devices was the main risk factor for patients over the five years.

Risk factors of addictive behavior in adolescents in Tunisia

Background

Adolescence is a period of physical, psychological and sociocultural transformation, but also of curiosity and experimentation. In Tunisia, the levels of use of some psychoactive substances, especially alcohol, tobacco and cannabis, remain high among adolescents, despite progress in regulatory efforts to limit access to these products by minors, and regular prevention campaigns. We aimed to determine the prevalence of addictive behavior among students in the region of Sousse and to specify the risk factors.

Materials/Methods

We conducted a cross-sectional epidemiological study in two public schools in the governorate of Sousse during the 2017/2018 school year. All students in each class were included when they agreed to participate in the study. The data was collected by anonymous self-questionnaire, then processed and analyzed using the SPSS version 20 software.

Results

In total, 294 students participated in this study with a mean age of 17.03 ± 1.51 years. A female predominance was noted (56.1%). The prevalence of addictive behavior was 52% (95% CI = [45.9% - 57.8%]). In univariate analysis, male gender, advanced age, and repeating the study year were significantly associated with addictive behavior (p = 0.014, p &lt; 10-3, p = 0.004 respectively). However, multivariate analysis showed that the probability of addictive behavior decreased in students who read books frequently (OR = 0.6, 95% CI = [0.37 - 0.96], p = 0.03). The only independent risk factor associated with addictive behavior was age (OR = 1.34, 95% CI = [1.14 - 1.59], p &lt; 10-3).

Conclusions

The findings have implications for identifying protection factors and risk factors for addictive behaviors, and the development of primary prevention strategies derived from such factors.

Key messages

Our results highlight the need to better understand behaviors at risk in Tunisia and the perceptions of prevention policies among students. Knowledge of related factors is important for prevention program planning.

Validation of the Arabic version of the Bergen Facebook Addiction Scale in Tunisian adolescents

Background Facebook is by far the most popular social network. Thus, it is important to use a valid measuring tool. This study aimed to validate an Arabic version of the Bergen Facebook Addiction Scale (BFAS). Methods It was a cross-sectional study conducted among public secondary schools, within the city of Sousse, Eastern Tunisia over 2 months. Students completed self-administrated questionnaires. The revised test-retest version of the scale was given to a sample of ten pilot students in order to check the readability of the translation. Internal consistency was measured using Cronbach's alpha coefficient in order to assess the extent to which the BFAS items were interrelated. Results A total of 1399 participants took part in the study (60.5% females). Among 1353 students who are using Facebook, 71.8% had non-problematic use. The median score of addiction was 13 ranging from 6 to 30. The median time spent each day on Facebook was 3 h. The Cronbach's alpha coefficient was 0.87. Students with higher Facebook addiction scores were significantly more addicted to video games (p = 0.001), and more depressed (p < 0.0001). Conclusion The Arabic-BFAS is consistent as a screening test for Facebook addiction among secondary school students due to having good reliability and validity.

[Study of unexpectedly detected repolarization in a group of black athletes]

INTRODUCTION

Sudden death that occurs during sporting activity affects patients with ignored heart disease. Black athlete's ECG has been little studied and the features of this ethnic group have been discussed. This study aims to study the epidemiological profile and the peculiarities of repolarization of black athletes.

METHODS

We conducted a descriptive study of black athletes selected among all the athletes followed in the sectoral Center of Sports Science and Medicine in Sousse over a period of 8 months from March to October 2014. Data were collected using a medical questionnaire.

RESULTS

Data on 35 athletes were collected, with a male predominance (94,28%), with an average age of 24,34 years. Four athletes had left ventricular hypertrophy on cardiac ultrasound. There were 8 athletes with atrioventricular block degree I and 8 athletes with electrical type of left ventricular hypertrophy (LVH). ST segment changes were more marked at the level of precordial leads. Five athletes (14.2%) had inverted T waves in V2 and V3. These were the same athletes who ST-segment depression in these same leads. Early repolarization was found in 3 athletes. All these cases had notch signaling.

CONCLUSION

Black athletes have quite specific electrical modifications which are important to know. However, our sample is not sufficiently large to certify these results. A comparative study of white athletes would be very interesting.

[Evaluation of the quality of long-term anticoagulation therapy with antivitamin-K in atrial fibrillation]

AIM

To assess the quality of long-term anticoagulation therapy with antivitamin-K in patients with atrial fibrillation by measuring the TTR and to determine the factors associated with a good TTR.

PATIENTS AND METHODS

This is an observational study conducted over a period of three years (from January 2013 until December 2015) in the outpatient clinic of cardiology of Farhat Hached hospital of Sousse, Tunisia. Pre-established individual plugs were used for data collection. The data analysis was performed using the SPSS Software, version 20.

RESULTS

Overall, 200 patients were eligible. Half of the patients did not know the risks of AVK and 29.1% were unaware of their interest. The average TTR was 57.3±18.2%. Good control of anticoagulation was obtained in 24.5% of patients. Those with a≥70% were more autonomous, observant, of urban origin, living in Sousse and Kairouan, with good knowledge about AVK and having a small left atrium. The factors associated negatively with TTR were hypertension, diabetes, old AF, hematological diseases, high number of medications taken daily and the presence of mitral insufficiency, mitral valve replacement, a tricuspid insufficiency or a tricuspid plasty.

CONCLUSION

The quality of AVK anticoagulation in AF patients is insufficient. Improving this indicator would reduce the morbidity and mortality associated with AVK treatment.

Incidence and risk factors of peripheral venous catheter-related adverse events in cardiology department of a Tunisian university hospital: A prospective observational study

AIM

The purpose of our study was to determine the incidence and risk factors of Peripheral Venous Catheter-Related Adverse Events (PVCAEs) in a cardiology department of a university hospital.

PATIENTS AND METHODS

We carried out a prospective observational study from Mars 2017 to May 2017 in the cardiology department of the University Hospital of Farhat Hached in Sousse, Tunisia. During this period, we actively followed-up all inserted PVCs (every 12hours) from insertion up to 48hours after removal. Regression analyses were applied and significance limits were set at P<0.05.

RESULTS

Data were analysed for 210 PVCs (794 PVC-days) in 148 patients. The incidence of PVCAEs was 33.33% with density of incidence of 8.81/1000 PVC-days. PVCAEs were mainly pain (50%) and mechanical events (31.42%). Infections accounted for 11.42%. The most frequent mechanical PVCAEs, was haematoma (15.71%). Multivariate analysis revealed as independent factors for the occurrence of PVCAEs: the hydro electrolytic nature of the injected product (OR=13.42, P<10-3), the medicinal nature of the injected product (OR=5.08, P=0.003), bad cutaneous state (OR=8.08, P=0.003), admission during nightshift (OR=3.76; P=0.014) and advanced age (OR=1.04, P=0.042).

CONCLUSION

Multicenter studies would be very useful to better analyze risk factors associated with PVCAEs.

[Smoking attitudes and behavior of the hospital staff Sahloul (Sousse, Tunisia)]

BACKGROUND

Smoking is a major public health problem. Legislation banning smoking in public institutions exists but is not strictly enforced, particularly in health facilities. Therefore health workers have a crucial role to play in the control of smoking on account of their contact with patients and their credibility and moral authority in health matters. They can help patients by their advice and by abstaining from smoking in the hospital themselves. The aim of our study was to determine the prevalence of smoking among medical staff at the University Hospital of Sahloul in Sousse and their attitudes and behaviour with regard to smoking.

METHODS

The data came from a descriptive cross-sectional study conducted during the year 2013-2014 using a self-administered questionnaire and included the health personnel of all services and laboratories of the University Hospital of Sahloul in Sousse.

RESULTS

The participation rate was 71% (768/1081). Our study population was predominantly female (51%) with a mean age of 37.8 (±11.3) years. The overall prevalence of smoking was 21%. It was significantly higher among men (38.8%) than women (4.6%). This prevalence was higher among physicians/pharmacists (29.5%). More than half the smokers (58%) started smoking between the age of 19 and 25 years. Nicotine dependence was moderate among 27.4% and strong among 18.3% of smokers. The average dependence score was 4.1±2.4 [0-9] with a median of 4.0. Two-thirds of smokers (66.5%) reported smoking in the workplace.

CONCLUSION

Confronted with the problem of tobacco, health institutions should find solutions for the prevention of smoking in hospitals. It seems necessary to train and involve hospital staff in anti-tobacco measures and to help smokers to quit in order to make our hospital a tobacco smoke free space.

Simulation of an asymmetric contacted carbon nanotube for solar-energy harvesting

Nanostructured materials offer great prospects in helping solar-energy harvesting devices to achieve their envisioned performances. Carbon nanotubes (CNT)-based devices were among the first to be proposed for this task. These devices are based on CNT field-effect transistors and CNT diodes. In this paper, the photovoltaic behavior of a diode structure formed from an asymmetrically contacted intrinsic CNT with scandium and palladium electrodes as source and drain, respectively, is investigated. A semi-classical simulator, which combines a quantum solution, for transmission through the electrodes/CNT interfaces with the semi-classical drift-diffusion equation and continuity equation for charge transport in the CNT has been built. The obtained simulation outcomes are compared with the available published experimental results.

Common iliac artery stenosis presenting as renal allograft dysfunction in two diabetic recipients

BACKGROUND

Suprarenal common iliac artery stenosis is an uncommon but reversible cause of allograft dysfunction in renal transplant recipients.

METHOD

We describe two diabetic renal transplant recipients with worsening hypertension, edema, and azotemia. Magnetic resonance angiography (MRA) demonstrated tight stenoses in the common iliac artery proximal to the allograft anastomosis site with patent renal transplant artery in both cases. These findings were later confirmed with carbon dioxide angiography.

RESULTS

No acute rejection was noted on renal biopsy in either case. Placement of percutaneous iliac artery Wallstents resulted in decrease of serum creatinine from 6.5 to 2.0 mg/dl and 1.7 to 1.0 mg/dl within 2 and 4 weeks, respectively.

CONCLUSION

Common iliac artery stenosis should be suspected in renal transplant recipients presenting with worsening hypertension, edema and azotemia. MRA for screening followed by carbon dioxide angiography and placement of intravascular stents for focal vascular obstructive lesions reverses allograft dysfunction.

Psychiatric reports requested by the courts in six countries

Consecutive series of individuals for whom psychiatric reports were requested by the courts in the context of criminal proceedings were studied in six countries: Brazil, Denmark, Egypt, Swaziland, Switzerland, Thailand. A total sample of 96 cases was obtained. Careful study of the court records and psychiatric reports revealed three types of situation which could trigger a request for such a report; an ‘offence-oriented’ response where the offence itself is seen as indicative of mental morbidity, a ‘patient-oriented’ response in which the patient's previous contact with the mental health system serves as trigger and a ‘behaviour-oriented’ response in which the patient's disturbed behaviour in detention or in court arouses concern. The majority of the individuals were first offenders (60 per cent), while a similar proportion had had previous psychiatric treatment.