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Zemni I, Gara A, Bennasrallah C, Ezzar S, Kacem M, Chokri R, Maatouk A, Abroug H, Dhouib W, Fredj MB, Bouanene I, Belguith AS. Incidence and risk factors of post COVID-19 syndrome: a Tunisian cohort study. BMC Infect Dis 2024; 24:461. [PMID: 38693500 DOI: 10.1186/s12879-023-08949-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 12/24/2023] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND It has become increasingly clear that SARS-CoV-2 infection can lead to persistent physical and mental health problems lasting weeks or months, requiring prolonged periods of clinical care and increasing the burden on the healthcare system. This phenomenon, known as post COVID-19 syndrome (PCS), is a relatively new condition, its incidence is still unclear and differs between studies. OBJECTIVES In this cohort study, we aimed to estimate the incidence of PCS and to identify its risk factors in the Tunisian population. METHODS This is a prospective cohort study that enrolled patients diagnosed with COVID-19 from the triage unit of the University Hospital of Monastir, Tunisia. between April 2021 and June 2022. Patients were contacted by phone for a follow-up evaluation of PCS 12- weeks after the diagnosis date. RESULTS A total of 1451 individuals diagnosed with COVID-19 during the study period, responded to the follow-up evaluation after 3 months. The incidence of PCS was found to be 44.03% (95% CI [41.47; 46.58]), with fatigue being the most common symptom (21.5%), followed by cognitive impairment (10.3%), including memory loss and difficulty concentrating. Multivariate analysis revealed that the main associated factors to PCS were female gender (RR = 1.54; CI95% [1.30 - 1.82]), pre-existing comorbidities (RR = 1.30; CI95% [1.10 - 1.52]), duration of acute COVID-19 illness (days) (RR = 1.02; CI95% [1.01 - 1.03]), hospitalization (RR = 1.27; CI95% [1.05 - 1.53]), number of COVID-19 episodes (RR = 1.46; CI 95% [1.28 - 1.67]) and patients having receive two or more doses of vaccine prior to COVID-19 infection (RR = 0.82; CI95% [0.70 - 0.96]). CONCLUSION Our study allowed to estimate the incidence and identify risk factors of PCS. Recognizing these factors could help to better understand the underlying mechanisms and guide interventions for prevention and management of this condition.
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Affiliation(s)
- Imen Zemni
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia.
- Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, University of Monastir, Monastir, Tunisia.
| | - Amel Gara
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Cyrine Bennasrallah
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, University of Monastir, Monastir, Tunisia
| | - Salma Ezzar
- Department of Family Medicine, Faculty of Medicine of Monastir, Monastir, Tunisia
| | - Meriem Kacem
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, University of Monastir, Monastir, Tunisia
| | - Roua Chokri
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Amani Maatouk
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Hela Abroug
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, University of Monastir, Monastir, Tunisia
| | - Wafa Dhouib
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, University of Monastir, Monastir, Tunisia
| | - Manel Ben Fredj
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, University of Monastir, Monastir, Tunisia
| | - Ines Bouanene
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Asma Sriha Belguith
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, University of Monastir, Monastir, Tunisia
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Zemni I, Bennasrallah C, Charrada I, Dhouib W, Maatouk A, Hassine DB, Klii R, Kacem M, Fredj MB, Abroug H, Mhalla S, Mastouri M, Loussaief C, Jlassi I, Bouanène I, Belguith AS. Comparison of time to negative conversion of SARS-CoV-2 between young and elderly among asymptomatic and mild COVID-19 patients: a cohort study from a national containment center. Front Med (Lausanne) 2024; 11:1217849. [PMID: 38562375 PMCID: PMC10983848 DOI: 10.3389/fmed.2024.1217849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 01/29/2024] [Indexed: 04/04/2024] Open
Abstract
Objective We aimed to study the relationship between age and time to negative conversion of SARS-CoV-2 in patients with asymptomatic and mild forms of COVID-19. Methods We conducted a cohort study including all patients diagnosed with COVID-19 from the national COVID-19 containment center of Tunisia. Patients were subdivided into two cohorts: (under 60 years) and (over 60 years) and were followed up until PCR negativization. Log rank test and Cox regression were applied to compare time to negative conversion between the old group and the young group. Results The study included 289 patients with non-severe forms of COVID-19. Age over 60 was significantly associated with delayed negative conversion in male sex (Hazard ratio (HR): 1.9; 95% CI: 1.2-3.07) and among patients with morbid conditions (HR:1.68; 95% CI: 1.02-2.75) especially diabetics (HR: 2.06; 95% CI: 1.01-4.21). This association increased to (HR:2.3; 95% CI: 1.13-4.66) when male sex and comorbidities were concomitantly present and rose to (HR: 2.63; 95% CI: 1.02-6.80) for men with diabetes. Cox regression analysis revealed a significantly delayed negative conversion in symptomatic patients. Significant interaction was observed between gender and age and between age and chronic conditions. Conclusion Age is associated with delayed negative conversion of viral RNA in certain subgroups. Identifying these subgroups is crucial to know how prioritize preventive strategies in elderly.
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Affiliation(s)
- Imen Zemni
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Faculty of Medicine of Monastir, Department of Epidemiology, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory, University of Monastir, Monastir, Tunisia
| | - Cyrine Bennasrallah
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Faculty of Medicine of Monastir, Department of Epidemiology, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory, University of Monastir, Monastir, Tunisia
| | - Ines Charrada
- Department of Endocrinology, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Wafa Dhouib
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Faculty of Medicine of Monastir, Department of Epidemiology, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory, University of Monastir, Monastir, Tunisia
| | - Amani Maatouk
- Department of Microbiology, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Donia Ben Hassine
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Faculty of Medicine of Monastir, Department of Epidemiology, University of Monastir, Monastir, Tunisia
| | - Rim Klii
- Department of Internal Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Meriem Kacem
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Faculty of Medicine of Monastir, Department of Epidemiology, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory, University of Monastir, Monastir, Tunisia
| | - Manel Ben Fredj
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Faculty of Medicine of Monastir, Department of Epidemiology, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory, University of Monastir, Monastir, Tunisia
| | - Hela Abroug
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Faculty of Medicine of Monastir, Department of Epidemiology, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory, University of Monastir, Monastir, Tunisia
| | - Salma Mhalla
- Department of Microbiology, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Maha Mastouri
- Department of Microbiology, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Chawki Loussaief
- Department of Infectiology, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Ines Jlassi
- Faculty of Sciences of Monastir, Department of Mathematics and Statistics, University of Monastir, Monastir, Tunisia
| | - Ines Bouanène
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Faculty of Medicine of Monastir, Department of Epidemiology, University of Monastir, Monastir, Tunisia
| | - Asma Sriha Belguith
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Faculty of Medicine of Monastir, Department of Epidemiology, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory, University of Monastir, Monastir, Tunisia
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Kacem M, Bennasrallah C, Abroug H, Ben Fredj M, Zemni I, Dhouib W, Gara A, Maatouk A, Aloui I, Nouira S, Bouanene I, Sriha Belguith A. Burden and predictions of hospitalized injuries in a low-middle income country: results from a Tunisian university hospital. Libyan J Med 2023; 18:2266238. [PMID: 37807671 PMCID: PMC10563618 DOI: 10.1080/19932820.2023.2266238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/29/2023] [Indexed: 10/10/2023] Open
Abstract
Injuries are responsible for a high premature mortality and disability. They are poorly explored in low and middle income-countries. We aimed to estimate the burden of hospitalized injuries in the Monastir governorate (Tunisia) according to the nature of the injury, trends and projections of hospitalizations for injuries up until 2024, and to identify the distribution of this disease burden based on age and sex. We performed a descriptive study from 2002 to 2012 including all hospitalizations for injuries. Data were collected from morbidity and mortality register of the University Hospital of Monastir (Tunisia). We estimated the burden of injuries using the Disability Adjusted Life Years (DALYs). We described injuries (crude prevalence rate (CPR) and age standardized prevalence rate (ASR)), related mortality (lethality and standardized mortality ratio (SMR)), trends and prediction for 2024. A total of 18,632 hospitalizations for injuries representing 10% of all hospitalizations during study period were recorded. Per 1000 inhabitants per year, CPR was 3.36 and the ASR was 3.44. The lethality was of 17.5 deaths per 1000 injured inpatients per year and the SMR was of 2.95 (Confidence Interval of 95%: 2.64-3.29). Burden related to injuries was 2.36 DALYs per 1000 population per year, caused mainly by Years of Life Lost (83.4%), most frequent among men aged under 40 years. The predicted ASR for 2024 was 4.46 (3.81-5.23) per 1000 person-years. Injuries to the head was the most prevalent (20.7%) causing 67.7% of DALYs; and increasing by 226% through 2024. Injuries had a high prevalence and an important burden in a Tunisian university hospital. Prediction showed increased prevalence for 2024. Preventive measures and a trauma surveillance register should be implemented soon.
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Affiliation(s)
- Meriem Kacem
- Department of Preventive Medicine, University of Monastir, Monastir, Tunisia
| | - Cyrine Bennasrallah
- Department of Preventive Medicine, University of Monastir, Monastir, Tunisia
| | - Hela Abroug
- Department of Preventive Medicine, University of Monastir, Monastir, Tunisia
| | - Manel Ben Fredj
- Department of Preventive Medicine, University of Monastir, Monastir, Tunisia
| | - Imen Zemni
- Department of Preventive Medicine, University of Monastir, Monastir, Tunisia
| | - Wafa Dhouib
- Department of Preventive Medicine, University of Monastir, Monastir, Tunisia
| | - Amel Gara
- Department of Preventive Medicine, University of Monastir, Monastir, Tunisia
| | - Ameni Maatouk
- Department of Preventive Medicine, University of Monastir, Monastir, Tunisia
| | - Issam Aloui
- Orthopedic Department, University of Monastir, Monastir, Tunisia
| | - Samir Nouira
- Emergency Department, University of Monastir, Monastir, Tunisia
| | - Ines Bouanene
- Department of Preventive Medicine, University of Monastir, Monastir, Tunisia
| | - Asma Sriha Belguith
- Department of Preventive Medicine, University of Monastir, Monastir, Tunisia
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Guedria A, Slama H, Fredj MB, Miladi S, Kefi HE, Gatti S, Oumaya A. Assessing parents' and children's psychological well-being and its associated factors during the COVID-19 lockdown in a Tunisian-North African population. BMC Public Health 2023; 23:2280. [PMID: 37978377 PMCID: PMC10657148 DOI: 10.1186/s12889-023-17206-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The rapidly emerging Coronavirus infectious disease 2019 (COVID-19) has spread around the world yielding in significant changes in almost every aspect of daily life. While primary research of the epidemic COVID-19 has focused on the psychological impact on the general population and health professionals, no survey of the pandemic-resulting containment on parents and their children has been yet addressed in the Tunisian-North African population. This study aimed to assess the psychological profile of parents and youth in Tunisia during a period of COVID 19 lockdown, and to identify associated factors to parental anxiety symptoms. METHODS This is an analytical cross-sectional study composed of a total of 538 adults including 464 mothers and 74 fathers. Parents of children aged less than 18 years completed an online survey (Google Forms) on the Psychological Impact of Confinement which includes the Generalized Anxiety Scale (GAD-7), the Parental Burnout Assessment (PBA), and the infantile trait-anxiety scale. The survey was initiated in May 2020 on a population of the Tunisian-North African citizens and lasted for more than 6 weeks. RESULTS The median GAD-7 score was 11 corresponding to a moderate anxiety with 27.8% reporting severe anxiety. The median PBA score was 31 corresponding to a moderate risk of burnout, with 19.5% being affected. The children's anxiety scores were associated with their parents' anxiety ratings with 24% of the children reported signs of moderate anxiety. CONCLUSIONS The COVID-19 pandemic affected parental and their children' psychological behavior due to a direct social isolation and distancing. Pediatricians need to be alerted on this issue and future measures are essential to avoid parental emotional burnout and anxiety disorder in similar situations.
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Affiliation(s)
- Asma Guedria
- University of Monastir, Monastir, Tunisia
- Department of Child and Adolescent Psychiatry, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Hela Slama
- University of Monastir, Monastir, Tunisia
- Military Hospital of Tunis, Tunis, Tunisia
| | - Manel Ben Fredj
- University of Monastir, Monastir, Tunisia.
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University, Hospital, University of Monastir, Monastir, Tunisia.
- Department of Community Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
| | - Shayma Miladi
- Department of Child and Adolescent Psychiatry, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Hamdi El Kefi
- Military Hospital of Tunis, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Syrine Gatti
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Abdelaziz Oumaya
- Military Hospital of Tunis, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Maatouk A, Gara A, Kacem M, Ben Fredj M, Zemni I, Abroug H, Bennasrallah C, Dhouib W, Grira Said S, Garrach S, Zouari I, Bergaoui H, Raja F, Bouanene I, Belguith Sriha A. Quality indicators of public maternity units in the governorate of Monastir (Tunisia). BMC Pregnancy Childbirth 2023; 23:731. [PMID: 37845621 PMCID: PMC10577896 DOI: 10.1186/s12884-023-05781-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/12/2023] [Indexed: 10/18/2023] Open
Abstract
INTRODUCTION Increasing access to healthcare for expectant mothers is a national goal. In Monastir, Tunisia, some Peripheral Maternity Units (PMUs) required assessment. Our goals were to describe the delivery activities in MUs (maternity units) and to assess whether some of PMUs need to have their activities replaced. METHOD We analyzed aggregate data of deliveries in Monastir from 2015 to 2020. The gouvernorate's seven public MUs were included. Only the morning activity was allotted for obstetricians and gynecologists, in RMUs 1 and 2, whereas they were not available in all PMUs. Data was gathered from the reports of the National Perinatal Program. Both the availability of Comprehensive Essential Obstetric Care (CEOC) and Basic Essential Obstetric Care (BEOC) were calculated. Trends were calculated using Joinpoint software. The Annual Percent Change (APC) was calculated. RESULTS The number of births decreased from 2015 to 2020 (APC= -4.3%: 95%CI : -6; -2.4; p = 0.003). The largest significant decreases in APCs of deliveries were reported in PMU 2 (APC = -12.6% (95%CI : -20; -4.4; p = 0.014), in PMU 3 (APC = -29.3% (95%CI : -36.5; -21.4; p = 0.001), and in PMU 4 (APC = -32.9% (95%CI: -49.1; -11.5); p = 0.016). If PMU 3 and 4 were no longer operating as maternity facilities, BEOC and CEOC standards would still be adequat. For accessibility, both PMU 3 and PMU 2 are accessible from PMU 4 and PMU 1, respectively. CONCLUSIONS Pregnant women prefer to give birth in obstetric services with ability to perform emergency caesarean at the expense of PMU. Nowadays, it appears that accessibility is less important than the presence of qualified human resources when a pregnant woman choose a maternity hospital.
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Affiliation(s)
- Amani Maatouk
- Department of Epidemiology and Preventive Medicine, University Hospital Fattouma Bourguiba of Monastir, Monastir, Tunisia
| | - Amel Gara
- Department of Epidemiology and Preventive Medicine, University Hospital Fattouma Bourguiba of Monastir, Monastir, Tunisia
| | - Meriem Kacem
- Department of Epidemiology and Preventive Medicine, University Hospital Fattouma Bourguiba of Monastir, Monastir, Tunisia
| | - Manel Ben Fredj
- Department of Epidemiology and Preventive Medicine, University Hospital Fattouma Bourguiba of Monastir, Monastir, Tunisia
| | - Imen Zemni
- Department of Epidemiology and Preventive Medicine, University Hospital Fattouma Bourguiba of Monastir, Monastir, Tunisia
| | - Hela Abroug
- Department of Epidemiology and Preventive Medicine, University Hospital Fattouma Bourguiba of Monastir, Monastir, Tunisia
| | - Cyrine Bennasrallah
- Department of Epidemiology and Preventive Medicine, University Hospital Fattouma Bourguiba of Monastir, Monastir, Tunisia
| | - Wafa Dhouib
- Department of Epidemiology and Preventive Medicine, University Hospital Fattouma Bourguiba of Monastir, Monastir, Tunisia
| | - Samia Grira Said
- The Regional Direction of Primary Health of Monastir, Monastir, Tunisia
| | - Saber Garrach
- Department of Obstetric and Gynecology, University Hospital Fattouma Bourguiba of Monastir, Monastir, Tunisia
| | - Ines Zouari
- Department of Obstetric and Gynecology, University Hospital Fattouma Bourguiba of Monastir, Monastir, Tunisia
| | - Hayfa Bergaoui
- Department of Obstetric and Gynecology, University Hospital Fattouma Bourguiba of Monastir, Monastir, Tunisia
| | - Falah Raja
- Department of Obstetric and Gynecology, University Hospital Fattouma Bourguiba of Monastir, Monastir, Tunisia
| | - Ines Bouanene
- Department of Epidemiology and Preventive Medicine, University Hospital Fattouma Bourguiba of Monastir, Monastir, Tunisia
| | - Asma Belguith Sriha
- Department of Epidemiology and Preventive Medicine, University Hospital Fattouma Bourguiba of Monastir, Monastir, Tunisia.
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Wannes S, Gamal GM, Fredj MB, Al Qusayer D, El Abed S, Sedky Y, Khalil M. Glucose control during Ramadan in a pediatric cohort with type 1 diabetes on MiniMed standard and advanced hybrid closed‑loop systems: A pilot study. Diabetes Res Clin Pract 2023; 203:110867. [PMID: 37544364 DOI: 10.1016/j.diabres.2023.110867] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Hybrid closed-loop (HCL) systems have revolutionized the treatment of diabetes, enabling doctors to cope with challenging conditions that were previously almost impossible to manage or were very risky and difficult. AIMS To assess the efficacy and safety of a hybrid closed-loop (HCL) system during Ramadan fasting in a pediatric cohort with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS Glucose control outcomes in older children and adolescents aged 8-16 years with automated insulin delivery for T1D were analyzed during Ramadan and 1 month before Ramadan. Participants on MiniMed standard HCL (670G) or advanced HCL (780G) systems of Medtronic were categorized as fasting or nonfasting. RESULTS The average age of the 19 participants (8 and 11 were on standard and advanced HCL systems, respectively) was 11.35 ± 2 years. Eleven patients fasted during Ramadan. Pump setup and sensor statistics were the same during Ramadan and the month before; no significant difference was found between the two groups in terms of insulin and glucose control metrics, with practically the same coefficient of variation, time in range (TIR) and time spent in hypoglycemia, maintained within the international recommended targets. Total daily doses were paradoxically higher in patients who fasted during Ramadan (p = 0.01), without repercussions on glucose control metrics. CONCLUSIONS Standard and advanced HCL use during Ramadan were safe and were associated with a maintained optimum TIR (>70 %) and no significant hypoglycemia in adolescents and older children with T1D.
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Affiliation(s)
- Selmen Wannes
- Department of Pediatrics, Mouwasat Hospital, Imam Al Termithy Street, Uhud, 32263 Dammam, Saudi Arabia; Faculty of Medicine of Monastir, University of Monastir, 5019 Monastir, Tunisia; Department of Pediatrics, University Hospital Thar Sfar de Mahdia, 5100 Mahdia, Tunisia.
| | - Gehad Mohamed Gamal
- Department of Pediatrics, Mouwasat Hospital, Imam Al Termithy Street, Uhud, 32263 Dammam, Saudi Arabia; Beni-Suef University, Beni-Suef, Egypt
| | - Manel Ben Fredj
- Faculty of Medicine of Monastir, University of Monastir, 5019 Monastir, Tunisia; Department of Epidemiology, University Hospital Fattouma Bourguiba, 5019 Monastir, Tunisia
| | - Dhai Al Qusayer
- Department of Pediatrics, Mouwasat Hospital, Imam Al Termithy Street, Uhud, 32263 Dammam, Saudi Arabia
| | - Sameh El Abed
- Diabetic Center, Mouwasat Hospital, Imam Al Termithy Street, Uhud, 32263 Dammam, Saudi Arabia
| | - Yasser Sedky
- Department of Pediatrics, Mouwasat Hospital, Imam Al Termithy Street, Uhud, 32263 Dammam, Saudi Arabia; Department of Pediatrics, Cairo University, Egypt
| | - Munther Khalil
- Department of Pediatrics, Mouwasat Hospital, Imam Al Termithy Street, Uhud, 32263 Dammam, Saudi Arabia
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Nasr S, Nsiri I, Fredj MB. Effectiveness of smoking cessation interventions for smokers with Crohn's disease: a systematic review. Future Sci OA 2023; 9:FSO870. [PMID: 37485443 PMCID: PMC10357394 DOI: 10.2144/fsoa-2022-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 05/10/2023] [Indexed: 07/25/2023] Open
Abstract
Aims Smoking cessation (SC) in Crohn's disease (CD) is widely accepted to be the most important modifiable factor to improve outcomes in these patients. We aimed in this review to provide a summary of the evidence base regarding the effectiveness of SC interventions in patients with CD. Materials & methods The following databases were systematically searched from inception to February 2022: PubMed, Google Scholar and Cochrane Library. Results Overall, five articles met the research criteria. Studies sample size ranged from 17 to 474 patients. At the outcome level, the abstinence rates ranged from 14.8 to 42% and was ≤25% in four studies. The three studies with control groups did not report statistically higher SC rates in the intervention groups. No predictors of interventions success were identified in this review. Conclusion Implementation and evaluation of tailored SC interventions for CD patients must be promptly addressed in further studies.
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Affiliation(s)
- Sahar Nasr
- Gastroenterology Department, University of Tunis, Tunisia
| | - Ilyess Nsiri
- Gastroenterology Department, University of Tunis, Tunisia
| | - Manel Ben Fredj
- Department of Preventive & Community Medicine, University of Monastir, Tunisia
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Zemni I, Gara A, Nasraoui H, Kacem M, Maatouk A, Trimeche O, Abroug H, Fredj MB, Bennasrallah C, Dhouib W, Bouanene I, Belguith AS. The effectiveness of a health education intervention to reduce anxiety in quarantined COVID-19 patients: a randomized controlled trial. BMC Public Health 2023; 23:1188. [PMID: 37340300 DOI: 10.1186/s12889-023-16104-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/11/2023] [Indexed: 06/22/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic is regarded as a serious public health concern that boosts levels of stress and anxiety which could be explained by several reasons, including social isolation. In this regard, we aimed to assess the impact of health education on the anxiety level of COVID-19 patients during the isolation period. METHODS This is a randomized controlled trial conducted between February 2021 and June 2021. Patients tested positive for Covid-19 with mild to moderate forms were randomized to Education (n = 267) or control (n = 269). The education group received a phone health education session on day 1 (D1) following the diagnosis. The three components of the health education intervention were an explanation of the coronavirus disease, what to do in the event of complications, and the recommended preventive measures. The two groups received a telephone evaluation of their Hospital Anxiety and Depression scores on D1 and day seven D7 following the positive diagnosis. The primary outcome was the rate of anxiety reduction in each group on D7 based on a HAD-A score ≥ 8. Secondary outcomes were the rate of anxiety reduction on D7 based on a HAD-A score ≥ 11, the percentage of people complying with isolation and the scores of adherences to preventive measures during the isolation in each group. RESULTS Hundred and ninety-six patients in the intervention group and 206 patients in the control group completed the study. The sociodemographic, clinical, and initial anxiety level features of the intervention and control groups were comparable at baseline (p ≥ 0.05). On D7, the education group's anxiety level (HAD-A ≥ 8) decreased from 26 to 16.3% (p = 0.013) while in the control group it increased from 19.4 to 22.8% (p = 0.37). Thus, the percentage change in anxiety between D1 and D7 (delta D7 - D1) was - 9.7% in the Education group and + 3.4% in the Control group. Using the HAD-A ≥ 11 thresholds, the percentage of anxiety decreased from 15.3 to 11.2% (p = 0.26) between D1 and D7, while it increased in the control group from 9.7 to 15.7% (p = 0.045). Thus, the education group's change in anxiety (delta D7 - D1) was - 4.1%, while the control group's change was + 6%. CONCLUSION During an outbreak, providing health education to quarantined patients may be beneficial to reduce the psychological impact of the disease. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT05715593, retrospectively registered on 8/02/2023 https://clinicaltrials.gov/ct2/results?term=NCT05715593&Search=Search .
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Affiliation(s)
- Imen Zemni
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia.
- Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, University of Monastir, Monastir, Tunisia.
| | - Amel Gara
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Hadhba Nasraoui
- Department of Emergency Medicine, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Meriem Kacem
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, University of Monastir, Monastir, Tunisia
| | - Amani Maatouk
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Oumeyma Trimeche
- Department of Endocrinology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Hela Abroug
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, University of Monastir, Monastir, Tunisia
| | - Manel Ben Fredj
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, University of Monastir, Monastir, Tunisia
| | - Cyrine Bennasrallah
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, University of Monastir, Monastir, Tunisia
| | - Wafa Dhouib
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, University of Monastir, Monastir, Tunisia
| | - Ines Bouanene
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Asma Sriha Belguith
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, University of Monastir, Monastir, Tunisia
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Fredj MB, Bennasrallah C, Amor I, Trimech F, Abroug H, Zemni I, Dhouib W, Kacem M, Bouanene I, Sriha AB. Associations of psychological factors, parental involvement, and adverse health behaviors with bullying among tunisian middle school students. BMC Psychol 2023; 11:154. [PMID: 37173773 PMCID: PMC10182717 DOI: 10.1186/s40359-023-01190-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Bullying is a serious problem that significantly affect adolescent well-being and health, needing the attention of teachers, school administrators, parents and public health professionals. In this study, we aimed at estimating the prevalence of bullying, from the perspective of victims in middle school students in the region of Monastir Tunisia, as well as analyzing its association with individual and family context variables. METHODS This is a cross-sectional study conducted in December 2017 and January 2018 among a sample of students from two middle schools in the region of Monastir (Tunisia), using the Global School-based Student Health Survey (GSHS) self-answered questionnaire. We defined bullying victimization as being bullied in at least one day in the previous 30 days. Binary logistic regression model was used to identify factors associated with being bullied. RESULTS Out of 802 students included in this study, nearly half (43.4%) reported having been bullied in the past month with CI 95%: 38.9-48.2. Gender did not interact with this behavior: (44.5%; CI 95%: 38.1-51.7) in boys versus (43.4% ; CI 95%: 37.2-50.2) in girls. Univariate analysis indicated significant differences regarding some individual factors such as physical fight, cigarette smoking, feeling lonely and being worried, in terms of prevalence of being bully victims. There were no significant differences in parental factors between the two groups (being bullied or not). Multivariate analysis showed the following factors as independently associated with bullying: being involved in physical fight (OR = 2.4; CI95%:1.77-3.25), feeling lonely (OR = 3.38; CI95% :2.04-5.57) and being worried (OR = 2.23; CI 95%:1.44-3.43). CONCLUSION Bullying victimization was common among school-going adolescents and was linked with physical fight and psychosocial distress. This study highlights the need for school-based violence prevention programs to address this problem among the students.
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Affiliation(s)
- Manel Ben Fredj
- Department of Epidemiology and Preventive Medicine, University Hospital Fattouma Bourguiba, Monastir, Tunisia
- Department of Community Medicine and Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Research Laboratory "Technology and Medical Imaging", Monastir, Tunisia
| | - Cyrine Bennasrallah
- Department of Epidemiology and Preventive Medicine, University Hospital Fattouma Bourguiba, Monastir, Tunisia.
- Department of Community Medicine and Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia.
- Research Laboratory "Technology and Medical Imaging", Monastir, Tunisia.
| | - Ines Amor
- Department of Epidemiology and Preventive Medicine, University Hospital Fattouma Bourguiba, Monastir, Tunisia
- Research Laboratory "Technology and Medical Imaging", Monastir, Tunisia
| | - Faouzia Trimech
- Directorate of school and university medicine of Monastir, Monastir, Tunisia
| | - Hela Abroug
- Department of Epidemiology and Preventive Medicine, University Hospital Fattouma Bourguiba, Monastir, Tunisia
- Department of Community Medicine and Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Imen Zemni
- Department of Epidemiology and Preventive Medicine, University Hospital Fattouma Bourguiba, Monastir, Tunisia
- Department of Community Medicine and Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Wafa Dhouib
- Department of Epidemiology and Preventive Medicine, University Hospital Fattouma Bourguiba, Monastir, Tunisia
- Department of Community Medicine and Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Meriem Kacem
- Department of Epidemiology and Preventive Medicine, University Hospital Fattouma Bourguiba, Monastir, Tunisia
- Department of Community Medicine and Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Research Laboratory "Technology and Medical Imaging", Monastir, Tunisia
| | - Ines Bouanene
- Department of Epidemiology and Preventive Medicine, University Hospital Fattouma Bourguiba, Monastir, Tunisia
- Department of Community Medicine and Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Asma Belguith Sriha
- Department of Epidemiology and Preventive Medicine, University Hospital Fattouma Bourguiba, Monastir, Tunisia
- Department of Community Medicine and Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Research Laboratory "Technology and Medical Imaging", Monastir, Tunisia
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Salah AH, Arem S, Fredj MB, Rekik M, Haddada I, Krifa B, Sghir M, Kessomtini W. Quality of life among adolescents with idiopathic scoliosis in Tunisia. Pan Afr Med J 2023; 45:27. [PMID: 37521762 PMCID: PMC10386519 DOI: 10.11604/pamj.2023.45.27.38575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/29/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction our study aimed to assess the quality of life (QOL) among adolescents with adolescent idiopathic scoliosis (AIS) receiving nonoperative treatment, and to identify the demographic and clinical factors associated with poor QOL. Methods this is a cross-sectional study. We included adolescents followed in the Department of Physical Medicine and Rehabilitation at Taher Sfar Hospital (Mahdia - Tunisia). The Quality-of-Life Profile for Spine Deformities (QLPSD), the Scoliosis Research Society 22 questionnaire (SRS-22) and the visual analogue scale objectifying the QOL (EVA QOL) were used. Correlations between the QOL domains and selected characteristics were performed. Results a total of 48 adolescents with AIS were included, with a mean age of 14.2 ± 2.1 years and a sex ratio (M/F) of 0.77. Adolescents who underwent rehabilitation treatment only had significantly better quality of life (QOL) scores than those with braces, as measured by three scales. Among brace wearers, we found a correlation between QOL and the degree of correction achieved by the brace, as measured by the EVA-QOL. We observed significant relationships between psychosocial status and age, correction angle, and treatment duration among braced patients, as measured by the QLPSD. Additionally, we found that dorsal flexibility was correlated with the correction angle and the treatment duration. According to the SRS-22, the overall QOL score of braced adolescents was significantly correlated with the correction obtained by the brace. Conclusion wearing a brace in adolescent with AIS leads to a significant decrease in QOL according to the three QOL assessment scales.
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Affiliation(s)
- Aymen Haj Salah
- Department of Physical Medicine and Rehabilitation, University Hospital Taher Sfar, Mahdia, Tunisia
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Soumaya Arem
- Department of Physical Medicine and Rehabilitation, University Hospital Taher Sfar, Mahdia, Tunisia
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Manel Ben Fredj
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Department of Epidemiology and Preventive Medicine, University Hospital Fattouma Bourguiba, Monastir, Tunisia
| | - Meriem Rekik
- Department of Physical Medicine and Rehabilitation, University Hospital Taher Sfar, Mahdia, Tunisia
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Ikram Haddada
- Department of Physical Medicine and Rehabilitation, University Hospital Taher Sfar, Mahdia, Tunisia
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Bessem Krifa
- Department of Physical Medicine and Rehabilitation, University Hospital Taher Sfar, Mahdia, Tunisia
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Mouna Sghir
- Department of Physical Medicine and Rehabilitation, University Hospital Taher Sfar, Mahdia, Tunisia
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Wassiaa Kessomtini
- Department of Physical Medicine and Rehabilitation, University Hospital Taher Sfar, Mahdia, Tunisia
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
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Slimene N, Bennasrallah C, Abroug H, Charrada I, Dhouib W, Zemni I, Fredj MB, Loussaief C, Sriha AB. COVID-19 during pregnancy: case report and literature review. Pan Afr Med J 2023; 45:9. [PMID: 37346923 PMCID: PMC10280957 DOI: 10.11604/pamj.2023.45.9.26980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 11/23/2020] [Indexed: 06/23/2023] Open
Abstract
The current coronavirus disease 2019 (COVID-19) pneumonia pandemic, caused by the newly discovered coronavirus is a serious public health emergency and a highly infectious disease. Evidence to date suggests that there are groups of people who are at a higher risk of getting severe COVID-19 disease such as pregnant women and their fetuses. We reported 4 cases of pregnant women with COVID-19 admitted in the national containment center, Tunisia (3 imported cases and one local case). The age range of the patients was 27-35 years and the range of gestational weeks at admission was 16 weeks to 32 weeks. None of the patients had underlying diseases. All four cases were totally asymptomatic and presented no complications. Two of them gave birth one by vaginal and the other by cesarean delivery, neonates presented no symptoms and no adverse outcomes. The current report does not present significant differences in the disease prognosis in the pregnant women´s group compared with the general women´s population. Careful observation, data collection and consecutive research are necessary.
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Affiliation(s)
- Nadia Slimene
- Department of Family Medicine, University of Monastir, Monastir, Tunisia
| | - Cyrine Bennasrallah
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Hela Abroug
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Ines Charrada
- Department of Endocrinology and Internal Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Wafa Dhouib
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Imen Zemni
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Manel Ben Fredj
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Chawki Loussaief
- Department of Infectiology, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Asma Belguith Sriha
- Department of Family Medicine, University of Monastir, Monastir, Tunisia
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
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Wannes S, Al Qusayer D, El Abed S, Ben Fredj M. Insulin pump therapy and glucose control during Ramadan fasting in an adolescent with type 1 diabetes: from an open-loop sensor-augmented pump therapy with predictive low-glucose management to an advanced hybrid closed-loop system. Acta Diabetol 2023; 60:851-855. [PMID: 36811739 PMCID: PMC9944769 DOI: 10.1007/s00592-023-02049-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 02/05/2023] [Indexed: 02/24/2023]
Affiliation(s)
- Selmen Wannes
- Department of Pediatrics, Mouwast Hospital Dammam, Imam Al Termithy Street, Uhud, Dammam, 32263, Saudi Arabia.
- Faculty of Medicine of Monastir, University of Monastir, 5019, Monastir, Tunisia.
- Department of Pediatrics, University Hospital Thar Sfar, 5100, Mahdia, Tunisia.
| | - Dhai Al Qusayer
- Department of Pediatrics, Mouwast Hospital Dammam, Imam Al Termithy Street, Uhud, Dammam, 32263, Saudi Arabia
| | - Sameh El Abed
- Diabetic Center, Mouwast Hospital Dammam, Imam Al Termithy Street, Uhud, Dammam, 32263, Saudi Arabia
| | - Manel Ben Fredj
- Faculty of Medicine of Monastir, University of Monastir, 5019, Monastir, Tunisia
- Department of Epidemiology, University Hospital Fattouma Bourguiba, 5019, Monastir, Tunisia
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Abroug H, Maatouk A, Bennasrallah C, Dhouib W, Ben Fredj M, Zemni I, Kacem M, Mhalla S, Nouira S, Ben Belgacem M, Nasri A, Klii R, Loussaief C, Ben Alya N, Bouanene I, Belguith Sriha A. Effect of vitamin D supplementation versus placebo on recovery delay among COVID-19 Tunisian patients: a randomized-controlled clinical trial. Trials 2023; 24:123. [PMID: 36803273 PMCID: PMC9940050 DOI: 10.1186/s13063-023-07114-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/23/2023] [Indexed: 02/22/2023] Open
Abstract
INTRODUCTION The present study aimed to determine the impact of vitamin D supplementation (VDs) on recovery delay among COVID-19 patients. METHODS We performed a randomized controlled clinical trial at the national COVID-19 containment center in Monastir (Tunisia), from May to August 2020. Simple randomization was done in a 1:1 allocation ratio. We included patients aged more than 18 years who had confirmed reverse transcription-polymerase chain reaction (RT-PCR) and who remained positive on the 14th day. The intervention group received VDs (200,000 IU/1 ml of cholecalciferol); the control group received a placebo treatment (physiological saline (1 ml)). We measured the recovery delay and the cycle threshold (Ct) values in RT-PCR for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The log-rank test and hazard ratios (HR) were calculated. RESULTS A total of 117 patients were enrolled. The mean age was 42.7 years (SD 14). Males represented 55.6%. The median duration of viral RNA conversion was 37 days (95% confidence interval (CI): 29-45.50) in the intervention group and 28 days (95% CI: 23-39) in the placebo group (p=0.010). HR was 1.58 (95% CI: 1.09-2.29, p=0.015). Ct values revealed a stable trend over time in both groups. CONCLUSION VDs was not associated with a shortened recovery delay when given to patients for whom the RT-PCR remained positive on the 14th day. TRIAL REGISTRATION This study was approved by the Human Subjects Protection Tunisia center (TN2020-NAT-INS-40) on April 28, 2020, and by ClinicalTrial.gov on May 12, 2021 with approval number ClinicalTrials.gov ID: NCT04883203 .
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Affiliation(s)
- Hela Abroug
- Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Monastir, Tunisia. .,Department of Community Medicine, Faculty of Medicine, University of Monastir, Monastir, Tunisia. .,Research LaboratoryTechnology and Medical Imaging - LTIM - LR12ES06, University of Monastir, Monastir, Tunisia.
| | - Amani Maatouk
- grid.420157.5Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Monastir, Tunisia
| | - Cyrine Bennasrallah
- grid.420157.5Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Monastir, Tunisia
| | - Wafa Dhouib
- grid.420157.5Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Monastir, Tunisia
| | - Manel Ben Fredj
- grid.420157.5Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Monastir, Tunisia ,grid.411838.70000 0004 0593 5040Department of Community Medicine, Faculty of Medicine, University of Monastir, Monastir, Tunisia ,grid.411838.70000 0004 0593 5040Research LaboratoryTechnology and Medical Imaging - LTIM - LR12ES06, University of Monastir, Monastir, Tunisia
| | - Imen Zemni
- grid.420157.5Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Monastir, Tunisia ,grid.411838.70000 0004 0593 5040Department of Community Medicine, Faculty of Medicine, University of Monastir, Monastir, Tunisia ,grid.411838.70000 0004 0593 5040Research LaboratoryTechnology and Medical Imaging - LTIM - LR12ES06, University of Monastir, Monastir, Tunisia
| | - Meriem Kacem
- grid.420157.5Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Monastir, Tunisia ,grid.411838.70000 0004 0593 5040Department of Community Medicine, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Salma Mhalla
- grid.411838.70000 0004 0593 5040Laboratory of Microbiology, University of Monastir, Monastir, Tunisia
| | - Sarra Nouira
- grid.411838.70000 0004 0593 5040Laboratory of Microbiology, University of Monastir, Monastir, Tunisia
| | - Manel Ben Belgacem
- grid.411838.70000 0004 0593 5040Department of Family Medicine, University of Monastir, Monastir, Tunisia
| | - Aymen Nasri
- grid.411838.70000 0004 0593 5040Department of Family Medicine, University of Monastir, Monastir, Tunisia
| | - Rim Klii
- grid.411838.70000 0004 0593 5040Department of Internal Medicine, University of Monastir, Monastir, Tunisia
| | - Chawki Loussaief
- grid.411838.70000 0004 0593 5040Department of Infectious Diseases, University of Monastir, Monastir, Tunisia
| | | | - Ines Bouanene
- grid.420157.5Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Monastir, Tunisia ,grid.411838.70000 0004 0593 5040Department of Community Medicine, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Asma Belguith Sriha
- grid.420157.5Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Monastir, Tunisia ,grid.411838.70000 0004 0593 5040Department of Community Medicine, Faculty of Medicine, University of Monastir, Monastir, Tunisia ,grid.411838.70000 0004 0593 5040Research LaboratoryTechnology and Medical Imaging - LTIM - LR12ES06, University of Monastir, Monastir, Tunisia
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Zemni I, Zemni K, Gara A, Maatouk A, Ben Fredj M, Abroug H, Kacem M, Benasrallah C, Dhouib W, Bouanene I, Belguith Sriha A. Associated factors with adherence to preventive behaviors related to COVID-19 among medical students in the university of Monastir, Tunisia. PLoS One 2023; 18:e0280921. [PMID: 36917588 PMCID: PMC10013900 DOI: 10.1371/journal.pone.0280921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/27/2022] [Indexed: 03/15/2023] Open
Abstract
INTRODUCTION Medical students should act as a model for the community in terms of compliance with preventive practices toward COVID-19. The aim of this study was to assess adherence to preventive behaviors related to COVID-19 among medical students and to identify its associated factors. POPULATION AND METHODS We conducted a cross-sectional survey in October 2020 in the faculty of medicine of Monastir. We included a representative sample of medical students during registration days for the 2020-2021 academic year. The data were collected through a self-administered anonymous questionnaire. Eleven items related to preventive practices against COVID-19 were assessed (respiratory hygiene practices (Six Item), hand hygiene practices (Three Items) and social distancing (two items)). Items were evaluated using a Likert scale of five points (from 0: (Never) to 4: (Always)). The score obtained from the sum of these items allowed to classify students into two categories: "Good compliance" if the score was ≥ 80% and "Poor compliance" if the score was less than 80%. Scores were compared according to the study population characteristics. Multivariate analysis was used to identify associated factors with good practices. The threshold of statistical significance was set at p < 0.05. RESULTS We included 678 medical students. The average age was 21.76 (SD = 1.89 years) with a sex ratio of 0.40. The protection measures most respected by the participants were related to the respiratory hygiene: correct coverage of the nose and mouth with the mask (80%), wearing masks regardless of the presence of symptoms (73.3%) and coverage of the mouth during coughing or sneezing (76.6%). Adherence to hand hygiene measures ranged from 51.4% to 66.3%. The least respected measures were related to social distancing: distancing of at least one meter from others (31.2%) and avoiding crowded places (42.5%). An overall score ≥ 80% was obtained among 61.5% of students. Referring to multivariate analysis, variables that positively affected the overall score of preventive measures related to COVID-19 were the female sex and living alone, with Beta coefficients of 3.82 and 1.37 respectively. The perceived level of stress, E-cigarette and Chicha consumption negatively affected the score with Beta coefficients of (-0.13), (-5.11) and (-2.33) respectively. CONCLUSION The level of adherence to good practice among medical students was overall moderate. Awareness programs would be needed in this population, especially for men and those who smoke and vape.
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Affiliation(s)
- Imen Zemni
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory—LTIM—LR12ES06, University of Monastir, Monastir, Tunisia
- * E-mail:
| | - Kaouthar Zemni
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Department of Family Medicine, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Amal Gara
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Amani Maatouk
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Manel Ben Fredj
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory—LTIM—LR12ES06, University of Monastir, Monastir, Tunisia
| | - Hela Abroug
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory—LTIM—LR12ES06, University of Monastir, Monastir, Tunisia
| | - Meriem Kacem
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory—LTIM—LR12ES06, University of Monastir, Monastir, Tunisia
| | - Cyrine Benasrallah
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory—LTIM—LR12ES06, University of Monastir, Monastir, Tunisia
| | - Wafa Dhouib
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory—LTIM—LR12ES06, University of Monastir, Monastir, Tunisia
| | - Ines Bouanene
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Asma Belguith Sriha
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory—LTIM—LR12ES06, University of Monastir, Monastir, Tunisia
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Garrouch S, Sallem A, Ben Fredj M, Kooli R, Bousabbeh M, Boughzala I, Sriha A, Hajjaji A, Mehdi M. Deleterious impact of COVID-19 pandemic: Male fertility was not out of the bag. PLoS One 2023; 18:e0284489. [PMID: 37155673 PMCID: PMC10166489 DOI: 10.1371/journal.pone.0284489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/31/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND The emergence and the spread of coronavirus disease (COVID-19) induced by the SARS-CoV-2 virus has multiple consequences in all countries around the world. Male germ cells of infertile patients which are shown to be vulnerable to many environmental conditions, could be particularly vulnerable to such an exceptional pandemic situation. We aimed through the current study to investigate the potential variations in sperm quality of infertile patients during the COVID-19 pandemic in Tunisia. METHODS This was a cohort study including 90 infertile patients addressed to Laboratory of Cytogenetics and Reproductive Biology of Monastir Department of Maternity and Neonatology in Monastir, during the two first COVID-19 waves in Tunisia and who already have a spermogram before the pandemic period. RESULTS We have pointed out a significant decrease in both total and progressive sperm motility during COVID-19 pandemic (p<0.0001 and p = 0.001 respectively). The percentage of morphologically abnormal spermatozoa increased from 90.99±7.38 to 93.67±4.55% during the pandemic (p< 0.001). The remaining sperm parameters were similar between the two compared timepoints. Interestingly, the univariate analysis didn't show any other associated factor to the observed impairment in sperm mobility and morphology. CONCLUSION These data highlight the severe impact of the pandemic of the male reproductive health of hypofertile patients. Delaying infertility investigations and management after pandemic waves is recommended to hope a better gamete quality and hence to improve conception potential.
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Affiliation(s)
- Siwar Garrouch
- Laboratory of Cytogenetics and Reproductive Biology, Maternity and Neonatology Center, Fattouma Bourguiba University Teaching Hospital, Monastir, Tunisia
| | - Amira Sallem
- Laboratory of Cytogenetics and Reproductive Biology, Maternity and Neonatology Center, Fattouma Bourguiba University Teaching Hospital, Monastir, Tunisia
- Laboratory of Histology-Embryology and Cytogenetics (LR18ES40), Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Manel Ben Fredj
- Department of Epidemiology and Preventive Medicine, Fattouma Bouguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Rim Kooli
- Laboratory of Cytogenetics and Reproductive Biology, Maternity and Neonatology Center, Fattouma Bourguiba University Teaching Hospital, Monastir, Tunisia
| | - Manel Bousabbeh
- Laboratory of Cytogenetics and Reproductive Biology, Maternity and Neonatology Center, Fattouma Bourguiba University Teaching Hospital, Monastir, Tunisia
| | - Ines Boughzala
- Laboratory of Cytogenetics and Reproductive Biology, Maternity and Neonatology Center, Fattouma Bourguiba University Teaching Hospital, Monastir, Tunisia
| | - Asma Sriha
- Department of Epidemiology and Preventive Medicine, Fattouma Bouguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Awatef Hajjaji
- Department of Gynecology and Obstetrics, Maternity and Neonatology Center, Fattouma Bourguiba University Teaching Hospital, Monastir, Tunisia
| | - Meriem Mehdi
- Laboratory of Cytogenetics and Reproductive Biology, Maternity and Neonatology Center, Fattouma Bourguiba University Teaching Hospital, Monastir, Tunisia
- Laboratory of Histology-Embryology and Cytogenetics (LR18ES40), Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
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Zemni I, Dhouib W, Sakly S, Bennasrallah C, Gara A, Kacem M, Ben Fredj M, Abroug H, Elbaroudi A, Bouanene I, Sriha Belguith A. Burnout syndrome among health care workers during the COVID-19 pandemic. A cross sectional study in Monastir, Tunisia. PLoS One 2023; 18:e0282318. [PMID: 36952480 PMCID: PMC10035826 DOI: 10.1371/journal.pone.0282318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 02/12/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Burnout syndrome may affect the safety of frontline healthcare care workers (HCW) and patients. We aimed to measure the prevalence of burnout among HCW in care facilities in Tunisia during the Covid-19 pandemic and to identify its associated factors. METHODS We conducted a cross-sectional study among HCW practicing during the covid-19 pandemic in health care facilities in the governorate of Monastir. Data collection was carried out using an anonymous self-administered questionnaire composed by three sections: epidemiological and clinical characteristics, professional conditions and the Maslach Burn out Inventory (MBI-HSS). RESULTS This study included 371 HCW. The prevalence of burnout was 77.9% (CI 95%: 73.6% - 82.1%). The severe level was found in 71 participants (19.1%), the moderate level in 115 (31%) and the low level in 103 (27.8%). The distribution of the levels of the burnout dimensions among the participants was as follows: high emotional exhaustion (EE) (57.4%), high depersonalization (DP) (39.4%) and low personal accomplishment (22.6%). The main determinants of burnout among healthcare professionals during COVID 19 pandemic were: working more than 6 hours per day (OR = 1.19; CI95% [1.06; 1.34]), physician function (OR = 1.17; CI 95% [1.05; 1.31]), feeling a negative impact of work on family life (OR = 1.40; 95% CI [1.13; 1.73]), and high personal estimation of COVID 19 exposure (OR = 1.15; CI95% [1.02; 1.29]). CONCLUSION During the COVID19 pandemic, the prevalence of burnout among health professionals was high. It was related to hard implication in COVID 19 management. Interventions like adjusting working hours, reducing workload, and providing psychological support should be taken.
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Affiliation(s)
- Imen Zemni
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory-LTIM-LR12ES06, University of Monastir, Monastir, Tunisia
| | - Wafa Dhouib
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory-LTIM-LR12ES06, University of Monastir, Monastir, Tunisia
| | - Sihem Sakly
- Emergency Department, Ksar Hellal Hospital, Monastir, Tunisia
| | - Cyrine Bennasrallah
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory-LTIM-LR12ES06, University of Monastir, Monastir, Tunisia
| | - Amel Gara
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Meriem Kacem
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory-LTIM-LR12ES06, University of Monastir, Monastir, Tunisia
| | - Manel Ben Fredj
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory-LTIM-LR12ES06, University of Monastir, Monastir, Tunisia
| | - Hela Abroug
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory-LTIM-LR12ES06, University of Monastir, Monastir, Tunisia
| | - Aicha Elbaroudi
- Department of Occupational Health, Ksar Hellal Hospital, Monastir, Tunisia
| | - Ines Bouanene
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Asma Sriha Belguith
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory-LTIM-LR12ES06, University of Monastir, Monastir, Tunisia
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Ksiaa I, Khochtali S, Mefteh M, Ben Fredj M, Ben Amor H, Abroug N, Khairallah M. Distinguishing swept-source optical coherence tomography findings in active toxoplasmic retinochoroiditis. Eye (Lond) 2022; 36:1222-1230. [PMID: 34117384 PMCID: PMC9151801 DOI: 10.1038/s41433-021-01491-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/27/2021] [Accepted: 02/23/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To define the swept-source optical coherence tomography (SS-OCT) features which distinguish ocular toxoplasmosis (OT) from other forms of retinochoroiditis. METHODS This is a prospective diagnostic study enrolling 43 eyes of 43 patients with active toxoplasmic (TOXO) retinochoroiditis matched to 54 eyes (54 lesions) with non-TOXO retinochoroiditis evaluated by structural SS-OCT. RESULTS The finding of retinal hyper-reflective round deposits, sub-lesional choroidal thickening, and sub-lesional retinal pigment epithelium elevation were more likely to be found in TOXO lesions with a positive likelihood ratio of 45.2 (95% CI: 6.45-316.56), 23.86 (95% CI: 6.09-93.36), and 9.79 (95% CI: 4.22-22.7), respectively. The presence of each of these findings was associated with a high level for positive predictive value (PPV) (88.63-97.29), negative predictive value (NPV) (88.3-92.45), sensitivity (83.72-90.69), and specificity (90.74-98.14). Two-parameter model binary logistic regression suggested that sub-lesional retinal pigment epithelium elevation and sub-lesional choroidal thickening were significant predictors of the diagnosis of OT (Wald = 11.905, p < 0.001; Wald = 14.881, p < 0.001; respectively). By adding hyper-reflective round deposits along the posterior hyaloid or the retinal surface the model improved its performance with very good diagnostic accuracy with area under the curve (AUC) values of 0.96 (95% CI: 0.9-0.99) for two parameters model and 0.98 (95% CI: 0.93-0.99) for the three parameters model. CONCLUSIONS Our results show that three OCT findings including retinal hyper-reflective round deposits, sub-lesional choroidal thickening, and sub-lesional retinal pigment epithelium elevation are more likely to occur in OT patients as compared with non-OT patients.
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Affiliation(s)
- Imen Ksiaa
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia.
| | - Sana Khochtali
- grid.411838.70000 0004 0593 5040Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Mossaab Mefteh
- grid.411838.70000 0004 0593 5040Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Manel Ben Fredj
- grid.411838.70000 0004 0593 5040Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Hajer Ben Amor
- grid.411838.70000 0004 0593 5040Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Nesrine Abroug
- grid.411838.70000 0004 0593 5040Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Moncef Khairallah
- grid.411838.70000 0004 0593 5040Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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Zemni I, Kacem M, Dhouib W, Bennasrallah C, Hadhri R, Abroug H, Ben Fredj M, Mokni M, Bouanene I, Belguith AS. Breast cancer incidence and predictions (Monastir, Tunisia: 2002–2030): A registry-based study. PLoS One 2022; 17:e0268035. [PMID: 35617209 PMCID: PMC9135193 DOI: 10.1371/journal.pone.0268035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/21/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Breast cancer is a major public health problem worldwide. It is the leading cause of cancer deaths in females. In developing countries like Tunisia, the frequency of this cancer is still growing. The aim of this study was to determine the crude and standardized incidence rates, trends and predictions until 2030 of breast cancer incidence rates in a Tunisian governorate. Methods This is a descriptive study including all female patients diagnosed with breast cancer in Monastir between 2002 and 2013. The data were collected from the cancer register of the center. Tumors were coded according to the 10th version of international classification of disease (ICD-10). Trends and predictions until 2030 were calculated using Poisson linear regression. Results A total of 1028 cases of female breast cancer were recorded. The median age of patients was 49 years (IQR: 41–59 years) with a minimum of 16 years and a maximum of 93 years. The age-standardized incidence rate (ASR) was of 39.12 per 100000 inhabitants. It increased significantly between 2002 and 2013 with APC of 8.4% (95% CI: 4.9; 11.9). Prediction until 2030 showed that ASR would reach 108.77 (95% CI: 57.13–209.10) per 100000 inhabitants. Conclusion The incidence and the chronological trends of breast cancer highlighted that this disease is of a serious concern in Tunisia. Strengthening preventive measures is a primary step to restrain its burden.
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Affiliation(s)
- Imen Zemni
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Faculty of Medicine of Monastir, Department of Epidemiology, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory—LTIM—LR12ES06, University of Monastir, Monastir, Tunisia
- * E-mail:
| | - Meriem Kacem
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Faculty of Medicine of Monastir, Department of Epidemiology, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory—LTIM—LR12ES06, University of Monastir, Monastir, Tunisia
| | - Wafa Dhouib
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Faculty of Medicine of Monastir, Department of Epidemiology, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory—LTIM—LR12ES06, University of Monastir, Monastir, Tunisia
| | - Cyrine Bennasrallah
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Faculty of Medicine of Monastir, Department of Epidemiology, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory—LTIM—LR12ES06, University of Monastir, Monastir, Tunisia
| | - Rim Hadhri
- Department of Pathology, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Hela Abroug
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Faculty of Medicine of Monastir, Department of Epidemiology, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory—LTIM—LR12ES06, University of Monastir, Monastir, Tunisia
| | - Manel Ben Fredj
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Faculty of Medicine of Monastir, Department of Epidemiology, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory—LTIM—LR12ES06, University of Monastir, Monastir, Tunisia
| | - Moncef Mokni
- Faculty of Medicine of Sousse, Department of Pathology, Farhat Hached University Hospital, University of Sousse, Sousse, Tunisia
- Cancer Register of the Center, Sousse, Tunisia
| | - Ines Bouanene
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Faculty of Medicine of Monastir, Department of Epidemiology, University of Monastir, Monastir, Tunisia
| | - Asma Sriha Belguith
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
- Faculty of Medicine of Monastir, Department of Epidemiology, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory—LTIM—LR12ES06, University of Monastir, Monastir, Tunisia
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Bennasrallah C, Ben Fredj M, Mhamdi M, Kacem M, Dhouib W, Zemni I, Abroug H, Belguith Sriha A. Animal bites and post-exposure prophylaxis in Central-West Tunisia: a 15-year surveillance data. BMC Infect Dis 2021; 21:1013. [PMID: 34579662 PMCID: PMC8477457 DOI: 10.1186/s12879-021-06700-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 09/15/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Rabies is a disease that still exists in developing countries and leads to more fatalities than other zoonotic diseases. Our study aimed to describe the profile of human exposures to animals over fifteen years and to assess the post-exposure prophylaxis (PEP) practices in the governorate of Kasserine (Tunisia) on pre- and post-revolution (2011). METHODS We carried out a descriptive study using surveillance data from a region in Central-West Tunisia. All humans exposed to animals, residents in Kasserine Governorate and declared to the regional directorate of primary health care (RDPH) from January 1st, 2004 to December 31st, 2018 were included. RESULTS A total of 45,564 cases of human exposures to animals were reported over the fifteen-year period of the study with an annual average of 3089.2 ± 403.1. The standardized incidence rate (SIR) of human exposures to animals was 694 per year per 100,000 inhabitants (inh). The most listed offending animal was the dog (91.3%) and the most reported type of exposure was bites (63.7%). The trend in human exposures to animals increased significantly over time. The number of exposures by vaccinated dogs decreased significantly and by unvaccinated and stray dogs increased steeply. When comparing pre-and post-revolution periods, the yearly average of animal exposures post-2011 was significantly greater than the average prior to 2011 (3200 ± 278.5 vs 2952.8 ± 483) (p < 0.001). The yearly average of animal bites post-2011 was significantly greater than the average prior to 2011 (2260.5 ± 372.1 vs 1609.8 ± 217.9) (p < 0.001). The average number of vaccine doses per animal exposure was 2.4. Concerning PEP protocols, protocol A (2 and 3 doses) was indicated in 79% of animal exposures cases. From 2004 to 2018, a downward trend was noted for protocol A (r = - 0.29, p < 0.001) and an upward trend for protocol B (3 and 5 doses) (r = 0.687, p < 0.001). During our study period, 5 fatal cases of human rabies were declared. CONCLUSION Rabies remains a major public health problem in Tunisia. The political dynamics had an impact on the health care system and rabies control. Preventive measures should be applied adequately to decrease the burden of this disease.
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Affiliation(s)
- Cyrine Bennasrallah
- Department of Epidemiology and Preventive Medicine, University Hospital Fattouma Bourguiba, University of Monastir, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, Monastir, Tunisia
| | - Manel Ben Fredj
- Department of Epidemiology and Preventive Medicine, University Hospital Fattouma Bourguiba, University of Monastir, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, Monastir, Tunisia
| | - Moncef Mhamdi
- Regional Directorate of Primary Health Care of Kasserine, Kasserine, Tunisia
| | - Meriem Kacem
- Department of Epidemiology and Preventive Medicine, University Hospital Fattouma Bourguiba, University of Monastir, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, Monastir, Tunisia
| | - Wafa Dhouib
- Department of Epidemiology and Preventive Medicine, University Hospital Fattouma Bourguiba, University of Monastir, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, Monastir, Tunisia
| | - Imen Zemni
- Department of Epidemiology and Preventive Medicine, University Hospital Fattouma Bourguiba, University of Monastir, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, Monastir, Tunisia
| | - Hela Abroug
- Department of Epidemiology and Preventive Medicine, University Hospital Fattouma Bourguiba, University of Monastir, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, Monastir, Tunisia
| | - Asma Belguith Sriha
- Department of Epidemiology and Preventive Medicine, University Hospital Fattouma Bourguiba, University of Monastir, Monastir, Tunisia
- Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, Monastir, Tunisia
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Dhouib W, Zemni I, Kacem M, Bennasrallah C, Fredj MB, Abroug H, Grira S, Mastouri M, Belguith AS. Syndromic surveillance of female sexually transmitted infections in primary care: a descriptive study in Monastir, Tunisia, 2007─2017. BMC Public Health 2021; 21:1625. [PMID: 34488704 PMCID: PMC8420027 DOI: 10.1186/s12889-021-11647-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 08/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sexually Transmitted Infections (STIs) are a public health problem, especially for reproductive-age women. The aim of this study was to determine the incidence and trend of STIs during 11 years in Tunisia (2007-17). METHODS We conducted a descriptive study including all women with curable STIs (chlamydia, gonorrhea, syphilis and trichomoniasis) diagnosed with the syndromic approach in all basic health care centers of the Governorate of Monastir (Tunisia) from 2007 to 2017. Syndromes included, Pelvic Pain (PP), Vaginal Discharge (VD) and Genital Ulceration (GU). RESULTS We analyzed 40,388 episodes of curable STIs with a crude incidence rate and age standardized incidence rate of 1393 (95% Confidence Interval (CI); 1348-1438) / 100,000 Person Year (PY) and 1328 (95%CI; 1284-1372) /100,000 PY respectively. The incidence rate showed a positive trend over 11 years for all age groups and syndromes. VD was the most common syndrome with a crude incidence rate of 1170/100,000 PY. For all syndromes, women aged 20 to 39 were the most affected age group (p < 0.001). CONCLUSION In conclusion, the incidence rate of STIs episodes among women diagnosed with the syndromic approach was high, consistent with the global evidence. Focusing on reviewing STIs surveillance system in low and middle-income countries could allow the achievement of the ending of STIs epidemics by 2030.
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Affiliation(s)
- Wafa Dhouib
- Department of Epidemiology and Preventive Medicine, University of Monastir, Monastir, Tunisia
| | - Imen Zemni
- Department of Epidemiology and Preventive Medicine, University of Monastir, Monastir, Tunisia
| | - Meriem Kacem
- Department of Epidemiology and Preventive Medicine, University of Monastir, Monastir, Tunisia
| | - Cyrine Bennasrallah
- Department of Epidemiology and Preventive Medicine, University of Monastir, Monastir, Tunisia
| | - Manel Ben Fredj
- Department of Epidemiology and Preventive Medicine, University of Monastir, Monastir, Tunisia
| | - Hela Abroug
- Department of Epidemiology and Preventive Medicine, University of Monastir, Monastir, Tunisia
| | - Samia Grira
- The Regional Direction of Primary Health of Monastir, Monastir, Tunisia
| | | | - Asma Sriha Belguith
- Department of Epidemiology and Preventive Medicine, University of Monastir, Monastir, Tunisia
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21
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Safer M, Letaief H, Hechaichi A, Harizi C, Dhaouadi S, Bouabid L, Darouiche S, Gharbi D, Elmili N, Ben Salah H, Hammami M, Talmoudi K, Moussa R, Charaa N, Termiz H, Ltaief F, Tounekti H, Makhlouf M, Belguith Sriha A, Ben Fredj M, Khalfallah S, Jabrane H, Mchirgui S, Amich C, Dabghi R, Anez Z, Abdelkader L, Mhamdi M, Ouerfeli N, Zoghlami S, Bougatef S, Chahed MK, Bouafif Ben Alaya N. Identification of transmission chains and clusters associated with COVID-19 in Tunisia. BMC Infect Dis 2021; 21:453. [PMID: 34011266 PMCID: PMC8132040 DOI: 10.1186/s12879-021-06107-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 04/22/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aim of this study was to characterize the transmission chains and clusters of COVID-19 infection in Tunisia. METHODS All cases were confirmed by Reverse Transcriptase Polymerase Chain Reaction of a nasopharyngeal specimen. Contact tracing is undertaken for all confirmed cases in order to identify close contacts that will be systematically screened and quarantined. Transmission chains were identified based on field investigation, contact tracing, results of screening tests and by assessing all probable mode of transmission and interactions. RESULTS As of May 18, 2020, 656 cases out of a total of 1043 confirmed cases of Coronavirus disease 2019 belong to 127 transmission chains identified during the epidemic (mean age 42.36 years, Standard deviation 19.56 and sex ratio 0.86). The virus transmission is the most concentrated in the governorate of Tunis (31.5%), Ariana (10.2%) and Ben Arous (10.2%). Virus transmission occurred 50 times (9.72% of secondary transmission events) between two different governorates. A maximum of seven generations of secondary infection was identified, whereas 62% of these secondary infections belong the first generation. A total of 11 "super spreader" cases were identified in this investigation. Four large clusters have been identified. The evolution of secondary cases highlighted two peaks: one in 2nd April and a second in 16 th April whereas imported cases caused local transmission of virus during the early phase of the epidemic. CONCLUSION Correct contact tracing and early active case finding is useful to identify transmission chains and source of infection in order to contain the widespread transmission in the community.
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Affiliation(s)
- Mouna Safer
- National Observatory of New and Emerging Diseases, Ministry Of Health, Tunis, Tunisia.
- Cardio Vascular Disease Epidemiology and Prevention Research Laboratory, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.
| | - Hejer Letaief
- National Observatory of New and Emerging Diseases, Ministry Of Health, Tunis, Tunisia
- Cardio Vascular Disease Epidemiology and Prevention Research Laboratory, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Aicha Hechaichi
- National Observatory of New and Emerging Diseases, Ministry Of Health, Tunis, Tunisia
- Cardio Vascular Disease Epidemiology and Prevention Research Laboratory, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Chahida Harizi
- Department of Epidemiology and Statistics, Abderrahman Mami Hospital, Ariana, Tunisia
| | - Sonia Dhaouadi
- National Observatory of New and Emerging Diseases, Ministry Of Health, Tunis, Tunisia
| | - Leila Bouabid
- National Observatory of New and Emerging Diseases, Ministry Of Health, Tunis, Tunisia
| | - Sondes Darouiche
- National Observatory of New and Emerging Diseases, Ministry Of Health, Tunis, Tunisia
| | - Donia Gharbi
- National Observatory of New and Emerging Diseases, Ministry Of Health, Tunis, Tunisia
| | - Nawel Elmili
- National Observatory of New and Emerging Diseases, Ministry Of Health, Tunis, Tunisia
| | - Hamida Ben Salah
- National Observatory of New and Emerging Diseases, Ministry Of Health, Tunis, Tunisia
| | - Mongi Hammami
- National Observatory of New and Emerging Diseases, Ministry Of Health, Tunis, Tunisia
| | - Khouloud Talmoudi
- National Observatory of New and Emerging Diseases, Ministry Of Health, Tunis, Tunisia
| | - Rim Moussa
- Public Health Surveillance Regional Departments, Tunis, Tunisia
| | - Nejib Charaa
- Public Health Surveillance Regional Departments, Tunis, Tunisia
| | - Hasna Termiz
- Public Health Surveillance Regional Departments, Tunis, Tunisia
| | - Fethi Ltaief
- Public Health Surveillance Regional Departments, Tunis, Tunisia
| | - Habib Tounekti
- Public Health Surveillance Regional Departments, Tunis, Tunisia
| | | | - Asma Belguith Sriha
- Department of Community and Preventive Medicine Faculty of Medicine, University of Monastir Tunisia, Tunis, Tunisia
| | - Manel Ben Fredj
- Department of Community and Preventive Medicine Faculty of Medicine, University of Monastir Tunisia, Tunis, Tunisia
| | | | - Houcine Jabrane
- Public Health Surveillance Regional Departments, Tunis, Tunisia
| | - Selma Mchirgui
- Public Health Surveillance Regional Departments, Tunis, Tunisia
| | - Chedli Amich
- Public Health Surveillance Regional Departments, Tunis, Tunisia
| | - Radhia Dabghi
- Public Health Surveillance Regional Departments, Tunis, Tunisia
| | - Zid Anez
- Public Health Surveillance Regional Departments, Tunis, Tunisia
| | | | - Moncef Mhamdi
- Public Health Surveillance Regional Departments, Tunis, Tunisia
| | - Nabil Ouerfeli
- Public Health Surveillance Regional Departments, Tunis, Tunisia
| | - Salah Zoghlami
- Public Health Surveillance Regional Departments, Tunis, Tunisia
| | - Souha Bougatef
- National Observatory of New and Emerging Diseases, Ministry Of Health, Tunis, Tunisia
- Cardio Vascular Disease Epidemiology and Prevention Research Laboratory, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Mohamed Kouni Chahed
- Department of Epidemiology and Public Health, Faculty of Medicine of Tunis, Tunis El-Manar University, Tunis, Tunisia
| | - Nissaf Bouafif Ben Alaya
- National Observatory of New and Emerging Diseases, Ministry Of Health, Tunis, Tunisia
- Cardio Vascular Disease Epidemiology and Prevention Research Laboratory, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
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22
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Bennasrallah C, Zemni I, Dhouib W, Sriha H, Mezhoud N, Bouslama S, Taboubi W, Beji MO, Kacem M, Abroug H, Fredj MB, Loussaief C, Belguith AS. Factors associated with a prolonged negative conversion of viral RNA in patients with COVID-19. Int J Infect Dis 2021; 105:463-469. [PMID: 33647508 PMCID: PMC7910140 DOI: 10.1016/j.ijid.2021.02.089] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/16/2021] [Accepted: 02/23/2021] [Indexed: 01/03/2023] Open
Abstract
Objectives The aim of this study was to identify the factors influencing the delay in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA negative conversion. Methods A cohort study was conducted that included patients with coronavirus disease 2019 (COVID-19) admitted to the Tunisian national containment center. Follow-up consisted of a weekly RT-PCR test. Multivariate Cox regression analysis was performed to determine independent predictors associated with negative RNA conversion. Results Among the 264 patients included, the median duration of viral clearance was 20 days (interquartile range (IQR) 17–32 days). The shortest duration was 9 days and the longest was 58 days. Factors associated with negative conversion of viral RNA were symptoms such as fatigue, fever, and shortness of breath (hazard ratio (HR) 0.600, 95% confidence interval (CI) 0.401–0.897) and face mask use when exposed to COVID-19 cases (HR 2.006, 95% CI 1.247–3.228). The median time to RNA viral conversion was 18 days (IQR 16–21 days) when using masks versus 23 days (IQR 17–36 days) without wearing masks, and 24 days (IQR 18–36 days) for symptomatic patients versus 20 days (IQR 16–30 days) for asymptomatic patients. Conclusions The results of this study revealed that during SARS-CoV-2 infection, having symptoms delayed viral clearance, while wearing masks accelerated this conversion. These factors should be taken into consideration for the strategy of isolating infected patients.
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Affiliation(s)
- Cyrine Bennasrallah
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia; Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia; Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, Monastir, Tunisia.
| | - Imen Zemni
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia; Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia; Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, Monastir, Tunisia.
| | - Wafa Dhouib
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia; Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia; Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, Monastir, Tunisia.
| | - Haythem Sriha
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia.
| | - Nourhene Mezhoud
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia.
| | - Samar Bouslama
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia.
| | - Wael Taboubi
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia.
| | - Meriem Oumaima Beji
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia.
| | - Meriem Kacem
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia; Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia; Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, Monastir, Tunisia.
| | - Hela Abroug
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia; Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia; Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, Monastir, Tunisia.
| | - Manel Ben Fredj
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia; Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia; Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, Monastir, Tunisia.
| | - Chawki Loussaief
- Department of Infectiology, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia.
| | - Asma Sriha Belguith
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia; Department of Epidemiology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia; Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, Monastir, Tunisia.
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23
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Dhouib W, Kacem M, bennasrallah C, Ben Fredj M, Abroug H, Zemni I, Chelly S, Maalel I, Samia GS, Belguith Sriha A. Hepatitis B birth vaccination, cohort study, Tunisia 2000-2017. Libyan J Med 2020; 15:1809223. [PMID: 32822288 PMCID: PMC7482885 DOI: 10.1080/19932820.2020.1809223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/03/2020] [Indexed: 01/20/2023] Open
Abstract
We aimed to compare the efficiency of the first dose of Hepatitis B (HB) vaccine: at Birth versus at 3 months and to evaluate the efficacy of HB vaccine. We conducted a cohort study in the governorate of Monastir. Vaccinated Cohort (VC) included populations receiving the first dose at 3 months (Protocol 1), and at birth (HepB-BD) (Protocol 2). First dose was followed by at least two doses. We collected, from January 2000 to December 2017, cases diagnosed by serological markers (hepatitis B surface antigen (HBsAg) and anti-HBc). We calculated Absolute Risk (AR) per 100,000 PY and the Relative risk reduction (RRR). Twenty-five cases were notified among VC and 1501 cases among not vaccinated cohort (NVC). Twenty-three cases were notified among the cohort receiving the first dose at 3 months and two cases in Protocol 2. The AR per 100,000 PY was 5.67 (CI95%: 3.36-7.99) in Protocol 1 and 0.11 (CI95%: 0.001-0.26) in Protocol 2. The RRR was 77% (95% CI: 66; 85) in Protocol 1 and 99.4% (95% CI: 97.8; 99.9) in Protocol 2. We identified 4 HB cases for children aged between 5 and 11 who benefited from protocol 1 (born between 2000 and 2006) and zero cases for children of the same age group benefiting from protocol 2 (born between 2011 and 2017). The annual number of HB has decreased from 112 in 2000 to 48 in 2017. We predicted 40 new cases of HB in 2030. HepB-BD was 99.4% effective at preventing HB. The continuity of HepB-BD worldwide would achieve WHO's goal of eliminating HB as a threat to health by 2050. ABBREVIATIONS AR: Absolute Risk; ARR: Absolute Risk Reduction; G1: Group1; G2: Group2; HB: Hepatitis B; HepB-BD: Hepatitis B Birth Dose; MENA: Middle East and North Africa; NNV: Number Needed to Vaccine; HIV: Human Immunodeficiency Virus; NVC: Not Vaccinated Cohort; PY: Person Year; RRR: Relative Risk Reduction; RR: Relative Risk; VC: Vaccinated Cohort; WHO: World Health Organization.
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Affiliation(s)
- Wafa Dhouib
- Department of Epidemiology and Preventive Medicine, University of Monastir, Monastir, Tunisia
| | - Meriem Kacem
- Department of Epidemiology and Preventive Medicine, University of Monastir, Monastir, Tunisia
| | - Cyrine bennasrallah
- Department of Epidemiology and Preventive Medicine, University of Monastir, Monastir, Tunisia
| | - Manel Ben Fredj
- Department of Epidemiology and Preventive Medicine, University of Monastir, Monastir, Tunisia
| | - Hela Abroug
- Department of Epidemiology and Preventive Medicine, University of Monastir, Monastir, Tunisia
| | - Imen Zemni
- Department of Epidemiology and Preventive Medicine, University of Monastir, Monastir, Tunisia
| | - Souhir Chelly
- Department of Epidemiology and Preventive Medicine, University of Monastir, Monastir, Tunisia
| | - Issam Maalel
- The Regional Direction of Primary Health of Monastir, Minister of Health, Tunisia
| | - Grira Said Samia
- The Regional Direction of Primary Health of Monastir, Minister of Health, Tunisia
| | - Asma Belguith Sriha
- Department of Epidemiology and Preventive Medicine, University of Monastir, Monastir, Tunisia
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24
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Ben Fredj M, Dhouib W, Kacem M, Bennasrallah C, Mehrez O, Abroug H, Zemni I, Gardabou A, Jamel K, Chouchene S, Rouatbi N, Belguith Sriha A. Trends and health burden of hospitalized acute respiratory infections and impact of Haemophilus influenza immunization in a Tunisian university hospital: a twelve-year study. Libyan J Med 2020; 15:1783048. [PMID: 32552441 PMCID: PMC7482779 DOI: 10.1080/19932820.2020.1783048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/09/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We aimed to describe the episodes and trends of admissions for community-acquired Respiratory Infections (RI) over a 12-year period and to assess the impact of Haemophilus influenza type b (Hib) vaccine on RI admissions in children aged up to 3 years. METHODS We conducted a twelve-year retrospective observational study on all community-acquired RI admitted to Fattouma Bourguiba Hospital in Monastir Governorate (Tunisia) from 1 January 2002 to 31 December 2013. RI cases were selected from the Regional Registry of Hospital Morbidity. Data were coded according to ICD-10. To assess the impact of the Hib vaccine, three cohorts were defined based on vaccine status (unvaccinated cohort, first vaccinated cohort (VC) by monovalent form and second VC by pentavalent combination). RESULTS Admissions for RI represented 17.6% (CI95%: 17.3-18.1) of all communicable diseases hospitalizations (n = 6 061/34 289). The crude incidence rates (CIR) per 100,000 inh were 24.2 for upper RI (URI) and 77.5 and for Lower RI (LRI) (p < 0.0001). Pneumonias represented 53.9% of LRI. Sex-ratio (male/female) was 1.12 for URI and 1.64 for LRI (p < 0.0001). At admission, the median age was 22 years (IQR: 3-52). Admission for Pneumonia increased significantly during study period (slope 'b' = 5.16; p < 0.0001) especially in children up to 5 years old (slope 'b' = 5.53) and in elderly (slope 'b' = 2.13). Among children up to 3 years old, the CIRs per 100,000 for Hib pneumonia admission were 11.6 in Non-Vaccinated Cohort (NVC), 10.6 in Vaccinated Cohort (VC) by protocol 1 (Hib Vaccine monovalent) and 0.80 in VC by protocol 2 (pentavalent vaccine combination).The relative risk reduction was 99% for protocol 2 (p < 0.001). CONCLUSION Admissions for RI in a tertiary level hospital were common with an increasing trend. The Hib immunization program, in particular the pentavalent combination, has had a positive impact on the reduction of related acute diseases.
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Affiliation(s)
- Manel Ben Fredj
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Department of Preventive and Community Medicine, University Hospital Fattouma Bourguiba, Monastir, Tunisia
- Research Laboratory “Technology and Medical Imaging” 12ES06, Tunisia
| | - Wafa Dhouib
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Department of Preventive and Community Medicine, University Hospital Fattouma Bourguiba, Monastir, Tunisia
- Research Laboratory “Technology and Medical Imaging” 12ES06, Tunisia
| | - Meriem Kacem
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Department of Preventive and Community Medicine, University Hospital Fattouma Bourguiba, Monastir, Tunisia
- Research Laboratory “Technology and Medical Imaging” 12ES06, Tunisia
| | - Cyrine Bennasrallah
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Department of Preventive and Community Medicine, University Hospital Fattouma Bourguiba, Monastir, Tunisia
- Research Laboratory “Technology and Medical Imaging” 12ES06, Tunisia
| | - Ons Mehrez
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Hela Abroug
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Department of Preventive and Community Medicine, University Hospital Fattouma Bourguiba, Monastir, Tunisia
- Research Laboratory “Technology and Medical Imaging” 12ES06, Tunisia
| | - Imen Zemni
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Department of Preventive and Community Medicine, University Hospital Fattouma Bourguiba, Monastir, Tunisia
- Research Laboratory “Technology and Medical Imaging” 12ES06, Tunisia
| | - Aicha Gardabou
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Koubaa Jamel
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Otorhinolaryngology Department, University Hospital Fattouma Bourguiba, Monastir, Tunisia
| | - Slaheddine Chouchene
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Pediatric Department, University Hospital Fattouma Bourguiba, Monastir, Tunisia
| | - Naceur Rouatbi
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Pneumology Department, University Hospital Fattouma Bourguiba, Monastir, Tunisia
| | - Asma Belguith Sriha
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Department of Preventive and Community Medicine, University Hospital Fattouma Bourguiba, Monastir, Tunisia
- Research Laboratory “Technology and Medical Imaging” 12ES06, Tunisia
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25
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El Mhamdi S, Lemieux A, Ben Fredj M, Bouanene I, Ben Salah A, Abroug H, Ben Salem K, al'Absi M. Social and early life adversity and chronic health conditions among Tunisian adults. Transl Behav Med 2020; 10:949-958. [PMID: 30551151 DOI: 10.1093/tbm/iby126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Early life adversities (ELAs) are shown as significant risk factors for chronic health conditions (CHCs). ELAs include multiple types of abuse such as the social abuse (peer, community, and collective violence). The purpose is to describe the relationship between childhood social abuse and chronic conditions in adulthood among a sample of adults in Tunisia and to investigate the role of obesity and tobacco use as mediators of this association. A cross-sectional study was conducted in Tunisia, from January to June 2016 using the Arabic Adverse Childhood Experiences International Questionnaire (ACE-IQ). Items of social abuse (peer violence, witnessing community violence, and exposure to collective violence) were analyzed. A total of 2,120 adults were enrolled. After adjustment for age, gender, and intrafamilial ELA, social adversities were associated significantly with the selected CHC. Experiencing more than two social ELA increase the risk of occurrence of hypertension and coronary diseases. After accounting for the indirect effect of body mass index, statistically significant partial mediation effects were observed for the cumulative number of social ELA as the exposure variable and chronic diseases as the outcome variable (p ≤ .001; % mediated = 44.5%). These findings support an association between many chronic health disorders and childhood social abuse, independently of intrafamilial ACEs.
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Affiliation(s)
- Sana El Mhamdi
- Department of Preventive and Community Medicine, University Hospital Tahar Sfar, Mahdia, Tunisia.,Department of Community Medicine, Faculty of Medicine, University of Monastir, Tunisia.,Research laboratory "Epidemiology Applied to Maternal and Child Health" Tunisia
| | - Andrine Lemieux
- Duluth Medical Research Institute, University of Minnesota, Duluth, MN, USA
| | - Manel Ben Fredj
- Department of Community Medicine, Faculty of Medicine, University of Monastir, Tunisia
| | - Ines Bouanene
- Department of Community Medicine, Faculty of Medicine, University of Monastir, Tunisia.,Research laboratory "Epidemiology Applied to Maternal and Child Health" Tunisia
| | - Arwa Ben Salah
- Department of Community Medicine, Faculty of Medicine, University of Monastir, Tunisia.,Research laboratory "Epidemiology Applied to Maternal and Child Health" Tunisia
| | - Hela Abroug
- Department of Community Medicine, Faculty of Medicine, University of Monastir, Tunisia
| | - Kamel Ben Salem
- Department of Community Medicine, Faculty of Medicine, University of Monastir, Tunisia.,Research laboratory "Epidemiology Applied to Maternal and Child Health" Tunisia
| | - Mustafa al'Absi
- Duluth Medical Research Institute, University of Minnesota, Duluth, MN, USA
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26
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Bennasrallah C, Bannour R, Jlassi O, Kacem M, Fredj MB, Abroug H, Zemni I, Garrach B, Bahri R, Charfeddine N, Triki S, Sriha AB. Three COVID-19 cases with a long-term viral shedding period in Tunisia. Pan Afr Med J 2020; 35:117. [PMID: 33282072 PMCID: PMC7687511 DOI: 10.11604/pamj.supp.2020.35.2.24950] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 12/28/2022] Open
Abstract
Novel coronavirus disease (COVID-19) caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has become a public health emergency of international concern. This was first emerged in Wuhan, Hubei Province, China, and then has become widespread all over the world. We report 3 cases (2 imported cases and 1 local case) with documented viral shedding (based on reverse transcription-polymerase chain reaction (RT-PCR) testing) of SARS-CoV-2 for 55, 59 and 63 days. Viral shedding duration was defined as the date of return from the COVID-19 pandemic countries for imported cases and from the first positive RT-PCR test for local cases, up to the second negative nasopharyngeal RT-PCR swab. These cases demonstrate that viral shedding after COVID-19 diagnosis can be prolonged.
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Affiliation(s)
- Cyrine Bennasrallah
- Department of Epidemiology and Preventive medicine, Fattouma Bouguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Rania Bannour
- Department of Epidemiology and Preventive medicine, Fattouma Bouguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Olfa Jlassi
- Department of Occupational Health and Ergonomics, University of Monastir, Monastir, Tunisia
| | - Mariem Kacem
- Department of Epidemiology and Preventive medicine, Fattouma Bouguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Manel Ben Fredj
- Department of Epidemiology and Preventive medicine, Fattouma Bouguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Hela Abroug
- Department of Epidemiology and Preventive medicine, Fattouma Bouguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Imen Zemni
- Department of Epidemiology and Preventive medicine, Fattouma Bouguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Behaeddine Garrach
- Department of Family Medecine, University of Monastir, Monastir, Tunisia
| | - Rihab Bahri
- Department of Family Medecine, University of Monastir, Monastir, Tunisia
| | | | - Sayda Triki
- Department of Family Medecine, University of Monastir, Monastir, Tunisia
| | - Asma Belguith Sriha
- Department of Epidemiology and Preventive medicine, Fattouma Bouguiba University Hospital, University of Monastir, Monastir, Tunisia.,Department of Occupational Health and Ergonomics, University of Monastir, Monastir, Tunisia
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Abdelkafi Koubaa A, Rouissi R, Ben Fredj M, Zemni I, Abroug H, Hmida S, Kacem M, Dhouib W, Gniwa OR, Mehrez O, Amor I, Belguith Sriha A. Prediction of cardiovascular events in primary Health care: a cross sectional study (Monastir-Tunisia). Tunis Med 2020; 98:573-580. [PMID: 33479956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION We aimed to determine the prediction of cardiovascular events in patients with hypertension and diabetes using the 10-year Framingham score. METHODS We conducted a cross sectional study in two primary health care centers in Monastir. We included patients with at least one conventional cardiovascular factors. Prediction of cardiovascular event were expressed by median and inter quartile range. RESULTS We included 409 patients. Age mean was 64 years (SD: 12.3), the sex ratio was 0.44. Patients with type 2 Diabetes were 278 (68%) and 295 had hypertension (72.1%). The global risk prediction at 10 years for cardiovascular diseases was 26.3%, It was 36.6% (26.4-46.8) for tobacco users, 29.7% (18.2-42.5) for patients with hypertension and 29.1 % (18.8-43.3) for those with diabetes. It increased significantly with the number of cardiovascular risk factors. The risk prediction for cardiovascular events, were significantly higher in men than in women (p < 0.01) and in non-controlled patients than in controlled patients (p <0.001). The risk prediction for cardiovascular diseases death was 3.6% (1.3-8.6). CONCLUSION Thirty percent of patients with hypertension or diabetes will develop cardiovascular diseases in 10 years. We suggest renforcing preventive actions to balance cardiovascular risk factors, including hypertension and diabetes.
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Abroug H, El Hraiech A, Mehrez O, Ben Fredj M, Zemni I, Ben Salah A, Azaiez M, Jomaa W, Maatouk F, Belguith A. Acute coronary syndrome: factors predicting smoking cessation. East Mediterr Health J 2020; 26:315-322. [DOI: 10.26719/emhj.19.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 07/05/2018] [Indexed: 11/09/2022]
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29
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Ben Salah A, El Mhamdi S, Ben Fredj M, Ben Meriem C, Bouguila J, Ben Helel K, Sfaihi L, Mustapha R, Sfar M, Soltani M. Hospital cost of invasive pneumococcal disease in children aged under 15 years old in Tunisia. East Mediterr Health J 2019; 25:861-871. [PMID: 32003444 DOI: 10.26719/emhj.19.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/27/2018] [Indexed: 11/09/2022]
Abstract
Background Pneumococcal infections are an important cause of morbidity and mortality in the world and in Tunisia. Data on the economic burden of these infections are needed to inform decision-making to include pneumococcal vaccinations in routine childhood immunization. Aims This study aimed to estimate the medical cost of hospitalizations due to invasive pneumococcal disease (pneumonia and meningitis) among children aged under 15 years old in Tunisia. Methods A prospective multicentre study was conducted in 15 paediatric departments, across different socio-economic areas of Tunisia, from June 2014 to May 2015. All children aged under 15 years old who were hospitalized for pneumococcal pneumonia or confirmed bacterial meningitis were enrolled. A case report form was completed for every eligible case. Activity Based Costing method was used to estimate the hospital cost. Data entry and statistical analysis were conducted using SPSS, version 20.0. Results During the study period, 727 children were hospitalized for pneumococcal pneumonia and 60 children were hospitalized for bacterial meningitis, among them 21(35%) had confirmed pneumococcal meningitis. The median hospital cost for pneumococcal pneumonia was 353.910 Tunisian Dinars (TND) and TND 1680.632 for pneumococcal meningitis. Using overall data extrapolation, it was estimated that nearly 1091 hospitalizations for pneumococcal pneumonia and 69 hospitalizations for pneumococcal meningitis occurred each year in Tunisian children aged under 15 years of age, incurring total costs of TND 502 079.408. Conclusion The economic burden of pneumococcal infections seems to be substantial in Tunisia. The estimated costs does not reflect the real costs of this infection. Cost-effectiveness studies would be helpful to inform policy-makers to take appropriate decisions.
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Affiliation(s)
- Arwa Ben Salah
- Service de Médecine préventive et d'Épidémiologie, Centre hospitalier universitaire (CHU), Monastir (Tunisie).,Laboratoire de recherche, Épidémiologie appliquée à la santé de la mère et de l'enfant, CHU Monastir, Tunisie
| | - Sana El Mhamdi
- Service de Médecine préventive et d'Épidémiologie, Centre hospitalier universitaire (CHU), Monastir (Tunisie).,Laboratoire de recherche, Épidémiologie appliquée à la santé de la mère et de l'enfant, CHU Monastir, Tunisie
| | - Manel Ben Fredj
- Service de Médecine préventive et d'Épidémiologie, Centre hospitalier universitaire (CHU), Monastir (Tunisie)
| | - Chebil Ben Meriem
- Laboratoire de recherche, Épidémiologie appliquée à la santé de la mère et de l'enfant, CHU Monastir, Tunisie.,Service de Pédiatrie, CHU, Monastir, Tunisie
| | - Jihen Bouguila
- Service de Pédiatrie, CHU Farhat Hached, Sousse, Tunisie
| | | | | | | | | | - Mohamed Soltani
- Service de Médecine préventive et d'Épidémiologie, Centre hospitalier universitaire (CHU), Monastir (Tunisie).,Laboratoire de recherche, Épidémiologie appliquée à la santé de la mère et de l'enfant, CHU Monastir, Tunisie
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Bennasrallah C, Kacem M, Dhouib W, Zemni I, Ben Fredj M, Abroug H, Djobbi A, Green A, Said SG, Maalel I, Stambouli S, Zhir W, Youssef HBH, Sriha Belguith A. BCG vaccination and tuberculosis prevention: A forty years cohort study, Monastir, Tunisia. PLoS One 2019; 14:e0219991. [PMID: 31381577 PMCID: PMC6682306 DOI: 10.1371/journal.pone.0219991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 07/04/2019] [Indexed: 11/26/2022] Open
Abstract
We aimed to describe incidence, trends of tuberculosis (TB) over 18 years and to evaluate the impact of the BCG vaccine after four decades of immunization program according to three protocols. We performed a cohort study including declared cases in Monastir from January 1, 2000 to December 31, 2017. We reported 997 cases of TB. The predominant site was pulmonarylocalization (n = 486). The age standardized incidence of pulmonary and lymph node TB per 100,000 inh were 5.71 and 2.57 respectively. Trends were negative for pulmonary TB (PTB) (b = - 0.82; r = -0.67; p<10−3) and positive for lymph node localization (b = 1.31; r = 0.63; p<10−3). We had not notified cases of HIV associated with TB. Crude incidence rate (CIR) of PTB per 100,000 inh was 8.17 in Non-Vaccinated Cohort (NVC) and 2.85 in Vaccinated Cohort (VC) (p < 0.0001). Relative risk reduction (RRR) of BCG vaccination was 65.1% (95%CI:57.5;71.4) for pulmonary localization and 65% (95%CI:55; 73) for other localizations. We have not established a significant RRR of BCG vaccination on lymph node TB. Protocol 3 (at birth) had the highest effectiveness with a RRR of 96.7% (95%CI: 86.6%; 99.2%) and 86% (95%CI:71%;91%) in patients with PTB and other localizations TB respectively. In Cox regression model the HR was 0.061 (95% CI 0.015–0.247) for PTB and 0.395 (95% CI 0.185–0.844) for other localizations TB in patients receiving protocol 3 compared to NVC. For lymph-node TB, HR was 1.390 (95% CI 1.043–1.851) for protocol 1 and 1.849 (95% CI 1.232–2.774) for protocol 2 compared to NVC. Depending on the three protocols, the BCG vaccine had a positive impact on PTB and other TB localizations that must be kept and improved. However, protocols 1 and 2 had a reverse effect on lymph node TB.
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Affiliation(s)
- Cyrine Bennasrallah
- Department of Epidemiology and Preventive Medicine, University of Monastir, Monastir, Tunisia
| | - Meriem Kacem
- Department of Epidemiology and Preventive Medicine, University of Monastir, Monastir, Tunisia
| | - Wafa Dhouib
- Department of Epidemiology and Preventive Medicine, University of Monastir, Monastir, Tunisia
| | - Imen Zemni
- Department of Epidemiology and Preventive Medicine, University of Monastir, Monastir, Tunisia
| | - Manel Ben Fredj
- Department of Epidemiology and Preventive Medicine, University of Monastir, Monastir, Tunisia
| | - Hela Abroug
- Department of Epidemiology and Preventive Medicine, University of Monastir, Monastir, Tunisia
| | - Amira Djobbi
- The Regional Direction of Primary Health of Monastir, Monastir, Tunisia
| | - Assia Green
- The Regional Direction of Primary Health of Monastir, Monastir, Tunisia
| | - Samia Grira Said
- The Regional Direction of Primary Health of Monastir, Monastir, Tunisia
| | - Issam Maalel
- The Regional Direction of Primary Health of Monastir, Monastir, Tunisia
| | - Sarra Stambouli
- Department of Family Medicine, University of Monastir, Monastir, Tunisia
| | - Wafa Zhir
- Department of Family Medicine, University of Monastir, Monastir, Tunisia
| | | | - Asma Sriha Belguith
- Department of Epidemiology and Preventive Medicine, University of Monastir, Monastir, Tunisia
- * E-mail:
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Sriha Belguith A, Beltaief K, Msolli MA, Bouida W, Abroug H, Ben Fredj M, Zemni I, Grissa MH, Boubaker H, Hsairi M, Nouira S. Management of acute coronary syndrome in emergency departments: a cross sectional multicenter study (Tunisia). BMC Emerg Med 2018; 18:50. [PMID: 30509187 PMCID: PMC6276213 DOI: 10.1186/s12873-018-0201-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 11/15/2018] [Indexed: 01/25/2023] Open
Abstract
Background We aimed to describe diagnosed acute coronary syndrome (ACS) and its care management and outcomes in emergency departments (EDs) and to determine related cardiovascular risk factors (CVRFs). Methods We conducted a cross sectional multicenter study that included 1173 adults admitted to EDs for acute chest pain (ACP) in 2015 at 14 sites in Tunisia. Data included patients’ baseline characteristics, diagnosis, treatment and output. Results ACS represented 49.7% of non-traumatic chest pain [95% CI: 46.7–52.6]; 74.2% of ACS cases were unstable angina/non-ST-segment-elevation myocardial infarction (UA/NSTEMI). Males represented 67.4% of patients with ACS (p < 0.001). The median age was 60 years (IQR 52–70). Emergency medical service transportation was used in 11.9% of cases. The median duration between chest pain onset and ED arrival was two hours (Inter quartile ranges (IQR) 2–4 h). The age-standardized prevalence rate was 69.9/100,000 PY; the rate was 96.24 in men and 43.7 in women. In the multivariable analysis, CVRFs related to ST segment elevation myocardial infarction were age correlated to sex and active smoking. CVRFs related to UA/NSTEMI were age correlated to sex, familial and personal vascular history and type 2 diabetes. We reported 27 cases of major adverse cardiovascular events (20.0%) in patients with STEMI and 36 in patients with UA/NSTEMI (9.1%). Conclusion Half of the patients consulting EDs with ACP had ACS. Emergency medical service transportation calls were rare. Management delays were acceptable. The risk of developing an UA/NSTEMI was equal to the number of CVRFs + 1. To improve patient outcomes, it is necessary to increase adherence to international management guidelines.
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Affiliation(s)
- Asma Sriha Belguith
- Epidemiology and Preventive Medicine Department, University Hospital of Monastir, Monastir, Tunisia.
| | - Kaouthar Beltaief
- Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia
| | | | - Wahid Bouida
- Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia
| | - Hela Abroug
- Epidemiology and Preventive Medicine Department, University Hospital of Monastir, Monastir, Tunisia
| | - Manel Ben Fredj
- Epidemiology and Preventive Medicine Department, University Hospital of Monastir, Monastir, Tunisia
| | - Imen Zemni
- Epidemiology and Preventive Medicine Department, University Hospital of Monastir, Monastir, Tunisia
| | | | - Hamdi Boubaker
- Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia
| | | | | | - Samir Nouira
- Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia
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Kacem M, Dhouib W, Bennasrallah C, Zemni I, Abroug H, Ben Fredj M, Sriha Belguith A. Expanded program of immunization in the Maghreb. Case study of Tunisia.Systematic review of the literature. Tunis Med 2018; 96:696-705. [PMID: 30746663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Vaccination is the most cost-effective intervention for primary prevention. The Maghreb countries had joined the The Expanded Programme on Immunization (EPI). Tunisia had also introduced the vaccine against hepatitis B and Haemophilus influenzae type B (Hib). OBJECTIVE To describ, through a systematic review, the specific documentation on the EPI in Tunisia. METHOD Target publications were collected using Medline database and Google Scholar from published articles from January 01 1998 to December 12 2017. The synthesis of the data was done according to four axes: "input", "process", "output" and "outcome". RESULTS 17 articles were analyzed, with an average of 4 publications every 5 years. The author's specialty was community and preventive medicine in 56% of cases. Six articles focused on the "input" vaccination program, five related to the immunization process and the other five articles examined output and outcomes. CONCLUSION Tunisian publications concerning vaccination were rare, their efficiency and impact on the change of national vaccination strategy was crucial. Research coordination between Maghreb countries is highly recommended to meet the growing information needs.
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Ben Fredj M, Sriha Belguith A, Abroug H, Dhouib W, El Mhamdi S, Ben Salah A, Bouanene I, Amara A, Bhiri S, Sahtout M, Loussaief C, Soussi Soltani M. Hospitalizations for communicable diseases in a developing country: prevalence and trends-Monastir, Tunisia, 2002-2013. Int J Infect Dis 2017; 55:102-108. [PMID: 28104505 DOI: 10.1016/j.ijid.2017.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 01/01/2017] [Accepted: 01/09/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In spite of the epidemiological transition, communicable diseases remain a public health problem and represent a significant cause of morbidity and mortality worldwide, especially in developing countries. This study aimed to determine the crude and standardized prevalence rates of hospitalizations for communicable disease (HCD) and to assess trends in HCD by age and sex at a university hospital in Tunisia over a period of 12 years (2002-2013). METHODS All cases of HCD from 2002 to 2013 in the university hospital departments were included. Data collected from the regional register of hospital morbidity were used. The discharge diagnoses were coded according to the International Classification of Diseases, 10th revision (ICD-10). RESULTS HCD represented 17.45% of all hospitalizations during the study period (34 289/196 488; 95% confidence interval 17.28-17.62%). The median age at the time of admission was 31 years (interquartile range (IQR) 15-52 years). The median hospital length of stay (LOS) was 5days (IQR 3-9 days). The crude prevalence rate (CPR) was 5.41 per 1000 inhabitants. The CPR was highest among patients aged ≥65 years. The four communicable disease categories that represented 70% of all HCD were abdominal infection, skin infection, genitourinary infection, and lower respiratory tract infection. The majority of HCD decreased over time; however, there was a significant increase in HIV diseases, tuberculosis, and viral hepatitis. CONCLUSION This study provides evidence of the epidemiological transition, showing a decline in communicable diseases, which needs to be sustained and improved.
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Affiliation(s)
- Manel Ben Fredj
- Research Laboratory (LR12 SP17), Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Monastir, Tunisia
| | - Asma Sriha Belguith
- Research Laboratory (LR12 SP17), Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Monastir, Tunisia.
| | - Hela Abroug
- Research Laboratory (LR12 SP17), Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Monastir, Tunisia
| | - Wafa Dhouib
- Family Medicine, Faculty of Medicine, Monastir, Tunisia
| | - Sana El Mhamdi
- Research Laboratory (LR12 SP17), Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Monastir, Tunisia
| | - Arwa Ben Salah
- Research Laboratory (LR12 SP17), Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Monastir, Tunisia
| | - Inès Bouanene
- Research Laboratory (LR12 SP17), Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Monastir, Tunisia
| | - Amal Amara
- Research Laboratory (LR12 SP17), Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Monastir, Tunisia
| | - Sana Bhiri
- Research Laboratory (LR12 SP17), Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Monastir, Tunisia
| | | | - Chawki Loussaief
- Department of Infectious Diseases, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Mohamed Soussi Soltani
- Research Laboratory (LR12 SP17), Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Monastir, Tunisia
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