Retinal changes in multiple sclerosis: An optical coherence tomography and angiography study

BACKGROUND

Multiple sclerosis (MS) is an autoimmune demyelinating disease of the central nervous system with neuroaxonal damage. It is the principal driver of non-traumatic disability in young adults. Visual symptoms are common and optic neuritis (ON) may be the revealing feature in up to 30% of cases. Structural optical coherence tomography (OCT) represents a biomarker of central nervous system neurodegeneration in MS. OCT-angiography (OCT-A) is a noninvasive tool allowing the study of retinal vasculature and the detection of microvascular damage in neuro-retinal diseases. In this study, we aimed to assess structural and microvascular retinal changes in patients with MS with and without ON and to correlate the findings with visual function and MS disability.

METHODS

We conducted a cross-sectional study including patients diagnosed with MS according to the 2017 McDonald criteria. All patients underwent complete neurological examination with evaluation of the Expanded Disability Status Scale (EDSS) and the Multiple Sclerosis Severity Score (MSSS) and an ophthalmological examination including OCT and OCT-A. Patients were compared with age- and sex-matched healthy subjects. The primary endpoints were assessment of retinal nerve fiber layer (RNFL) thickness, ganglion cell layer (GCL+), and ganglion cell complex (GCL++) thicknesses on OCT. Vascular densities in the superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris (CC) were assessed on OCT-A, as well as central avascular zone (CAZ) parameters, lacunarity and fractal dimension.

RESULTS

A total of 160 MS eyes with and without a previous history of ON and 64 age- and gender-matched healthy eyes were analyzed. Among 160 eyes with MS, 69 had a history of ON. We observed a decrease in RNFL and GCL++ thickness in all 12 quadrants in MS patients when compared to healthy controls. Multivariate analysis by linear regression noted a significant correlation for temporal GCL++ and inferonasal RNFL thickness that were decreased in the MS group. A greater decrease in retinal layers thickness was identified in MS patients with a history of ON. On OCT-A, vascular density in (SCP) was significantly reduced in the MS group (P<0.002). A significant correlation between RNFL thickness and retinal vascular density was found but only in less than half of the hourly quadrants. A significant correlation was noted between visual acuity and CC density (P<0.0001). We also noted an inverse correlation between EDSS scores and CC density (P=0.02 and r=-0.275) and between MSSS and RNFL/GCL++ thicknesses.

CONCLUSIONS

RNFL and GCL++ layers were thinner in MS patients with a history of ON and were reversely correlated with disease severity. Moreover, retinal vascular changes were observed in MS even in eyes without ON, and CC was reversely correlated with visual function and current disability. Thus, structural OCT coupled with OCT-A could represent a noninvasive and dynamic biomarker of MS severity and progression.

Cavernous hemangioma of the forearm muscles: Three case reports and literature review

Introduction

Hemangiomas are common benign vascular tumors. Intramuscular hemangioma is a very rare type of hemangioma occurring in the skeletal muscle. The lower limb muscles are more likely to be affected. The location within the muscles of the forearm is extremely rare.

Case Report

We present three cases of intramuscular hemangioma of the upper limb. Magnetic resonance imaging (MRI) revealed a vascular tumor within the pronator teres muscle in two cases and the extensor pollicis brevis muscle in the other. The tumors were surgically excised, and histopathologic examination confirmed the diagnosis of intramuscular cavernous hemangioma. The limb function was good and there was no recurrence at 12-month follow-up in the three cases.

Conclusion

Intramuscular hemangiomas of the forearm are a condition that should be evoked by orthopedic surgeons in front of pain and swelling of this region. MRI is the most effective imaging method to suspect the diagnosis.

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

Contexte

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

Méthodes

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

Résultats

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

Discussion/Conclusion

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

Déclaration de liens d'intérêts

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

Al2O3 Dot and Antidot Array Synthesis in Hexagonally Packed Poly(styrene-block-methyl methacrylate) Nanometer-Thick Films for Nanostructure Fabrication

Nanostructured organic templates originating from self-assembled block copolymers (BCPs) can be converted into inorganic nanostructures by sequential infiltration synthesis (SIS). This capability is particularly relevant within the framework of advanced lithographic applications because of the exploitation of the BCP-based nanostructures as hard masks. In this work, Al₂O₃ dot and antidot arrays were synthesized by sequential infiltration of trimethylaluminum and water precursors into perpendicularly oriented cylinder-forming poly(styrene-block-methyl methacrylate) (PS-b-PMMA) BCP thin films. The mechanism governing the effective incorporation of Al₂O₃ into the PMMA component of the BCP thin films was investigated evaluating the evolution of the lateral and vertical dimensions of Al₂O₃ dot and antidot arrays as a function of the SIS cycle number. The not-reactive PS component and the PS/PMMA interface in self-assembled PS-b-PMMA thin films result in additional paths for diffusion and supplementary surfaces for sorption of precursor molecules, respectively. Thus, the mass uptake of Al₂O₃ into the PMMA block of self-assembled PS-b-PMMA thin films is higher than that in pure PMMA thin films.

POS0361-PARE THE MEDIATING EFFECT OF PAIN CATASTROPHIZING ON WORK PRODUCTIVITY

Background

Work disability is a major patient outcome for spondyloarthritis (SpA) patients since SpA mostly appears in younger adults.

Objectives

we examined the influence of catastrophizing as a negative psychological factor on work productivity and activity impairment in SpA.

Methods

We conducted a cross-sectional study over a 3 months period. We included patients treated with SpA (Assessment of SpondyloArthritis International Society (ASAS) 2009 criteria). Patients related data, and disease characteristics were collected. Pain catastrophizing were assessed by the pain catastrophizing score (PCS). Work productivity and activity impairment were evaluated by Work productivity and Activity Impairment Questionnaire (WPAI). WPAI score examined four aspects of the patient’s life: Absenteeism due to SpA and presenteism at work, work productivity loss and activity impairment.

Results

Sixteen SpA patients were enrolled (22 females and 38 males). Mean age was 39,4 years ± 11,08. Mean disease duration was 11,37 years ±7,23; 28 were unemployed. Among workers, absenteeism due to SpA was reported in 7 cases (21,9%). Mean absenteeism rate was 2,35% [0-20]. Both mean work productivity loss and mean activity impairment were 50,23% [20-90].

Mean PCS was 15,73 ± 13,893. Thirteen patients (21,7%) had PCS >30 which indicates a clinically relevant level of catastrophizing, and only two of them reported absenteeism at work. PCS score was higher in patients with absenteeism (mean score=26), compared to patients without absenteeism (mean score=16,96), (p=0,166). Presenteeism was lower in patients with higher pain catastrophizing scores, without reaching a significant difference (p=0,066). A higher PCS was significantly correlated with a greater work productivity loss (p= 0,036, r=0,371) and greater activity impairment (p=0,005, r=0,36).

Conclusion

In our series, pain catastrophizing affected work productivity and daily activity in patients with SpA.

Disclosure of Interests

None declared

POS1540-HPR CENTRAL SENSITIZATION PLAYS A PROMINENT ROLE IN DISEASE ACTIVITY, FUNCTIONAL IMPAIRMENT AND QUALITY OF LIFE IN PATIENTS WITH SPONDYLOARTHRITIS

Background

Pain in rheumatic diseases is substantially due to an excess of nociception in response to chronic inflammation. However, the share of nociplastic pain in these disorders shouldn’t be overlooked. Different tests have been evaluated but some of them require expensive equipment.

Objectives

to assess The Central Sensitization in young patients with spondyloarthritis (SpA) using a simple and validated tool: The Central Sensitization Inventory (CSI).

Methods

We conducted a cross-sectional study including patients with SpA, fulfilling the Assessment of SpondyloArthritis International Society (ASAS) 2009 criteria. For all patients, we collected the following data: age, age at onset of SpA, disease duration, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing spondylitis quality of life score (ASQOL) and functional statement by Bath ankylosing spondylitis functional index (BASFI). Nociceptive pain was assessed by VAS pain, neuropathic pain was assessed by DN4 and nociplastic pain was assessed by CSI.

Univariable and multivariable linear regression analyses were used to investigate the association between CSI scores, patient-related parameters and disease characteristics.

Results

Sixteen SpA patients (50 axial SpA, 8 axial and peripheral SpA, 1 psoriatic arthritis and 1 SpA associated with inflammatory bowel disease) were enrolled. There were 22 females and 38 males. Mean age was 39,4 years ± 11,08, mean age at onset was 23,61 years± 8,5 and mean disease duration was 11,37 years ±7,23. Mean night awakenings was 0,92 [0, 3], mean VAS pain was 5,27 [1, 9]. Mean BASDAI was 3,53 ± 3,34, mean BASFI was 4,01 ± 2,53, mean ASQOL was 6,3 ± 5,128 and mean DN4 was 1,72 [0, 7].

Mean CSI score was 20,38 ± 18,657. Six patients (10%) had a CSI score≥ 40, which indicates a central sensitization. CSI score>40 was not associated with the gender (p=0,659), nor axial presentation of SpA (p=0,644), nor the presence of coxitis (p=0,217). CSI score was not correlated with disease duration (p=0,306) nor age at onset (p=0,376). It was however associated with a BASDAI>4 (p=0,039).

A positive correlation was found between higher CSI score and higher ASQOL (p<0,001, r=0,744), VAS pain (p=0,061, r=0,282), more frequent night awakenings (p=0,009, r=0,433), higher BASDAI (p=0,006, r=0,379) and higher BASFI (p=0,055, r=0,270).

Conclusion

Higher CSI score was associated with higher disease activity, more frequent night awakenings, poorer quality of life and greater functional impairment. A global and comprehensive management including these factors as well as nociplastic pain should help the patient achieve better outcomes.

Disclosure of Interests

None declared

POS1541-HPR PAIN CATASTROPHIZING IS FREQUENT AND IMPACTS THE LIFE AND FUNCTION OF PATIENTS WITH SPONDYLOARTHRITIS

Background

Psychological care for patients with spondyloarthritis (SpA) should be standard practice if we aim to achieve better outcomes. In fact, pain catastrophizing, anxiety, and depression are to look for when the patient remains unsatisfied despite the clinicobiological control of the disease.

Objectives

To assess the presence of pain catastrophizing among patients with SpA.

Methods

We conducted a cross-sectional study including patients with SpA, fulfilling the Assessment of SpondyloArthritis International Society (ASAS) 2009 criteria. For all patients, we collected the socio-demographic data and disease characteristics, the following scores: the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath ankylosing spondylitis functional index (BASFI), the Ankylosing spondylitis quality of life score (ASQOL) were used to evaluate respectively disease activity, functional status and quality of life. The presence of pain catastrophizing was assessed by the arabic validated version of Pain catastrophizing score (PCS) and nociplastic pain by Central Sensitization Inventory (CSI).

Results

We included 60 SpA patients (sex ratio=1,72). Mean age was 39,4 years ± 11,08. Mean disease duration was 11,37 years ±7,23. Mean BASDAI score was 3,53± 3,34, mean BASFI was 4,01 ±2,53 and mean ASQOL score was 6,3 ±5,12. Mean PCS was 15,73 ± 13,893. thirteen patients (21,7%) had PCS >30 which indicates clinically relevant level of catastrophizing. PCS was significantly higher in men (mean PCS was 19,29 in men versus 9,59 in females), p=0,003. Clinically relevant level of catastrophizing (PCS>30) was significantly associated with age: mean age was 45,61 years in patients with PCS>30 compared to 37,47 in patients with lower PCS (p=0,022). Higher PCS was correlated with greater central sensitization assessed by the CSI (p<0,0001, r=0,621), poorer quality of life assessed by the ASQOL (p<0,0001, r=0,818) and greater functional impairment appraised by BASFI (p=0,009, r=0,347). No correlation was shown between PCS and age (p=0,640, r=0,062), age at disease onset (p=0,580, r=-0,84), disease duration (p=0,805, r=0,037), patient’s global assessment (p=0,211, r=0,197), CRP value (p= 0,425, r=-0,130) and BASDAI score (p=0,073, r=0,244).

Conclusion

Pain catastrophizing was not influenced by inflammation parameters. PCS was correlated with greater central sensitization, poorer quality of life and greater functional impairment. Therefore, psycho-education should be investigated among patients with SpA.

Disclosure of Interests

None declared

Original implementation of low-temperature SPS for bioactive glass used as a bone biomaterial

Alkali borated bioactive glasses powders with compositions based on the SiO₂-Na₂O-CaO-P₂O₅-x B₂O₃ system (0 < x < 20 wt%); have been consolidated at low temperature using Spark Plasma Sintering (SPS). Through SPS technique under 50 MPa, it was possible to achieve fully dense and completely amorphous borated glasses at temperatures as low as 420 °C. By increasing the sintering temperature up to 430 °C, the dense samples crystallized which is mostly achieved at higher temperatures. This study reveals that the mechanical properties of these new borated biomaterials are suitable to be used as a promising candidate for repairing defects in non-load-bearing bones as well as for coating on the metallic surface implants to improve the bioactivity process bone/implant. The pressure had a weak effect on the crystallization and densification of the glass compared to the temperature during the powder consolidation by SPS. Moreover, by increasing the boron content, the compressive strength and the elastic modulus of the elaborated glasses decreased for being close to those of the natural.

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

Background

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

Methods

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

Results

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

Conclusions

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

Key messages

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

Intra-articular leiomyoma of the knee mimicking a ganglion cyst in a child: A case report and review of literature

INTRODUCTION AND IMPORTANCE

Angioleiomyoma is a rare benign soft tissue tumor of smooth muscle getting its origin from the muscular layer of vessel walls. The localized type of leiomyoma occurs on the skin, deep soft tissues, in the genitourinary, gastrointestinal, and respiratory tracts.

CASE PRESENTATION

We report a case of a 16-year-old patient who presented with an intra-articular leiomyoma developed in the anterior cruciate ligament and treated with arthroscopy.

CLINICAL DISCUSSION

Angioleiomyoma can occur anywhere in the body and is most often seen in the extremities, particularly the lower limbs, but is very rare in the knee joint. Angioleiomyoma should be included in the differential diagnosis of nodular lesions mimicking loose body, such as lipomas, inclusion cysts, ganglion, pigmented villonodular synovitis (PVNS), fibroma, nodular synovitis, hemangioma, synovial sarcoma, myopericytoma, leiomyosarcomas, glomus tumor.

CONCLUSION

Angioleiomyoma related to the cruciate ligaments of the knee should be considered in the differential diagnosis of a painful knee especially when associated with a decreased of range of motion of knee. The arthroscopic debridement should be considered the treatment of choice in order to reliably restore active ROM.

Primary sclerosing epithelioid fibrosarcoma presenting as lombosciatic syndrome: Case report and literature review

•

Sclerosing epithelioid fibrosarcoma (SEF) is a rare mesenchymal tumor.

•

SEF appears to be a slowly growing tumor often present for several months or years before diagnosis.

•

A tumor of the gluteal region may mimic a sciatic nerve pain.

•

SEF has a poor prognosis with high risk of metastasis.

•

The treatment is surgical.

Introduction and importance

Sclerosing epithelioid fibrosarcoma (SEF) is a rare variant of low grade fibrosarcoma, with specific histological and immunohistochemical features. SEF is a difficult to diagnose. The prognosis is poor with a 40% mortality rate.

Case presentation

We report a case of 45-year-old female patient who presented to our department with a history of right sciatalgia evolving for three months. On physical examination, a firmly not well-defined mass was found in the right gluteal region. The histological diagnosis revealed a SEF.

Clinical discussion

SEF appears to be a slowly growing tumor often present for several months or years before diagnosis. The 3-month delay of our diagnosis shows the difficulty arising from the inconclusive clinical of this tumor.

Conclusion

SEF of the gluteal region can induce sciatalgia. The diagnosis should be made as early as possible in order to improve the prognosis.

Resist-Free Directed Self-Assembly Chemo-Epitaxy Approach for Line/Space Patterning

This work reports a novel, simple, and resist-free chemo-epitaxy process permitting the directed self-assembly (DSA) of lamella polystyrene-block-polymethylmethacrylate (PS-b-PMMA) block copolymers (BCPs) on a 300 mm wafer. 193i lithography is used to manufacture topographical guiding silicon oxide line/space patterns. The critical dimension (CD) of the silicon oxide line obtained can be easily trimmed by means of wet or dry etching: it allows a good control of the CD that permits finely tuning the guideline and the background dimensions. The chemical pattern that permits the DSA of the BCP is formed by a polystyrene (PS) guide and brush layers obtained with the grafting of the neutral layer polystyrene-random-polymethylmethacrylate (PS-r-PMMA). Moreover, data regarding the line edge roughness (LER) and line width roughness (LWR) are discussed with reference to the literature and to the stringent requirements of semiconductor technology.

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

Background

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

Methods

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

Results

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

Conclusions

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

Key messages

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

Determinants of influenza vaccination intention among Tunisian elderly

Background

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

Methods

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

Results

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

Conclusions

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

Key messages

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

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

Background

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

Methods

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

Results

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

Conclusions

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

Key messages

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

Prevalence of seasonal Influenza vaccination among Tunisian elderly

Background

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

Methods

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

Results

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

Conclusions

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

Key messages

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

Biochemical parameters and oxidative stress markers in Tunisian patients with periodontal disease

Background

Oxidative stress is involved in many diseases including diabetes and cancer. Numbers of studies have suggested its involvement in the pathogenesis of periodontal diseases. The aim of this study was to evaluate the levels of biochemical parameters and oxidative stress markers in plasma of healthy and chronic periodontitis patients.

Methods

One hundred thirty subjects were divided into two groups; patients (mean age = 42 ± 13.6 y.o) and control (mean age = 44.8 ± 12.6 y.o). Patients and healthy subjects were free from any infection, coronary or heart disease, diabetes or liver failure. Total cholesterol, LDLc, HDLc, Triglycerides (TG), creatinine, uric acid (UA), glucose and urea levels as well as the activities of enzymatic antioxidants such as catalase, glutathione reductase (GR) and total antioxidant capacity (TAOC), were measured in plasma samples using colorimetric assays. Statistical differences between groups were determined by Student’s t-test and p ≤ 0.05 was considered as significant.

Results

Periodontitis patients exhibited significant decrease in the activities of catalase, TAOC, GR and TG, cholesterol, LDLc, glucose, HDLc, uric acid levels in plasma samples in comparison with healthy subjects. However, no statistically significant differences in the levels of creatinine and urea were observed between the two groups.

Conclusion

The reduction of plasma antioxidant activities (Catalase, TAOC, GR) may have a role in the pathogenesis of periodontal diseases. Our findings suggest a decrease in the host capacity to control the damage caused by oxidative stress. Therefore, therapeutic strategies, aiming at modulating the oxidative stress could be considered as potential tools for the prevention or treatment of periodontal diseases and their potential systemic effects on the general health.

X-ray characterization of contact holes for block copolymer lithography

The directed self-assembly (DSA) of block copolymers (BCPs) is a promising low-cost approach to patterning structures with critical dimensions (CDs) which are smaller than can be achieved by traditional photolithography. The CD of contact holes can be reduced by assembling a cylindrical BCP inside a patterned template and utilizing the native size of the cylinder to dictate the reduced dimensions of the hole. This is a particularly promising application of the DSA technique, but in order for this technology to be realized there is a need for three-dimensional metrology of the internal structure of the patterned BCP in order to understand how template properties and processing conditions impact BCP assembly. This is a particularly challenging problem for traditional metrologies owing to the three-dimensional nature of the structure and the buried features. By utilizing small-angle X-ray scattering and changing the angle between the incident beam and sample we can reconstruct the three-dimensional shape profile of the empty template and the residual polymer after self-assembly and removal of one of the phases. A two-dimensional square grid pattern of the holes results in scattering in both in-plane directions, which is simplified by converting to a radial geometry. The shape is then determined by simulating the scattering from a model and iterating that model until the simulated and experimental scattering profiles show a satisfactory match. Samples with two different processing conditions are characterized in order to demonstrate the ability of the technique to evaluate critical features such as residual layer thickness and sidewall height. It was found that the samples had residual layer thicknesses of 15.9 ± 3.2 nm and 4.5 ± 2.2 nm, which were clearly distinguished between the two different DSA processes and in good agreement with focused ion beam scanning transmission electron microscopy (FIBSTEM) observations. The advantage of the X-ray measurements is that FIBSTEM characterizes around ten holes, while there are of the order of 800 000 holes illuminated by the X-ray beam.

X-ray characterization of contact holes for block copolymer lithography

The directed self-assembly (DSA) of block copolymers (BCPs) is a promising low-cost approach to patterning structures with critical dimensions (CDs) which are smaller than can be achieved by traditional photolithography. The CD of contact holes can be reduced by assembling a cylindrical BCP inside a patterned template and utilizing the native size of the cylinder to dictate the reduced dimensions of the hole. This is a particularly promising application of the DSA technique, but in order for this technology to be realized there is a need for three-dimensional metrology of the internal structure of the patterned BCP in order to understand how template properties and processing conditions impact BCP assembly. This is a particularly challenging problem for traditional metrologies owing to the three-dimensional nature of the structure and the buried features. By utilizing small-angle X-ray scattering and changing the angle between the incident beam and sample we can reconstruct the three-dimensional shape profile of the empty template and the residual polymer after self-assembly and removal of one of the phases. A two-dimensional square grid pattern of the holes results in scattering in both in-plane directions, which is simplified by converting to a radial geometry. The shape is then determined by simulating the scattering from a model and iterating that model until the simulated and experimental scattering profiles show a satisfactory match. Samples with two different processing conditions are characterized in order to demonstrate the ability of the technique to evaluate critical features such as residual layer thickness and sidewall height. It was found that the samples had residual layer thicknesses of 15.9 ± 3.2 nm and 4.5 ± 2.2 nm, which were clearly distinguished between the two different DSA processes and in good agreement with focused ion beam scanning transmission electron microscopy (FIBSTEM) observations. The advantage of the X-ray measurements is that FIBSTEM characterizes around ten holes, while there are of the order of 800 000 holes illuminated by the X-ray beam.

An embedded neutral layer for advanced surface affinity control in grapho-epitaxy directed self-assembly

Advanced surface affinity control for grapho-epitaxy directed self-assembly (DSA) patterning is essential for providing reliable DSA-based solutions for the development of semiconductor patterning. Independent control of surface affinity between the bottom and the sidewalls of a topographical guiding structure was achieved by embedding an ultrathin layer in the guiding template stack. The implementation of an embedded layer with tunable surface properties for DSA grapho-epitaxy was evaluated and optimized on 300 mm wafers by critical dimension SEM characterization. It was demonstrated that a thin protective layer, placed between the hard mask guiding template and the embedded layer, allows the preservation of the surface properties of the embedded layer during guiding template etching. The DSA performances of this novel grapho-epitaxy integration, using a topographical template patterned with 193 nm immersion lithography, were evaluated by monitoring the success rate and the critical dimension uniformity of the shrunk contacts. FIB-STEM analyses were further carried out to analyze the residual polymer thickness on the resulting contacts. This new integration leads to the control of the polymer residual thickness (a few nanometers) and uniformity (inferior to 1 nm) at the bottom of the guiding template which will facilitate the subsequent DSA pattern transfer.

Effect of an external electric field on the smectic-Ctilted* phases

We are interested in the chiral tilted smectic subphases, smectic-C(tilted)(*), including commensurate structures as well as the incommensurate smectic-C(α)(*) one. The continuum theory defines two scalar order parameters I and J, which can be coupled with an external electric field through a linear term I × E and a dielectric term J × E(2). We have calculated the changes due to these terms in the phase diagrams in the (α,η) plane, where α comes from the spontaneous twist and η measures the strength of the biaxial order. The coupling with an external electric field induces the expansion of the areas with spontaneous polarization and the appearance of an electroazimuthal effect.