Antimicrobial prophylaxis protocol based on rectal swab culture before prostate biopsy to prevent infectious complications: a prospective randomized comparative study

PURPOSE

To evaluate the benefit of targeted antibiotic prophylaxis (TAP) based on rectal swab culture in comparison with standard empiric antimicrobial prophylaxis in patients undergoing transrectal ultrasound-guided needle biopsy of the prostate (TRUS-BP), as well as to assess rate of fecal carriage of Fluoroquinolone-resistant Enterobacterales FQRE.

PATIENTS AND METHODS

We prospectively analyzed data that randomized 157 patients within two groups: (G1) TAP according to rectal swab performed 10 days before PB; (G2): empirical antibiotic prophylaxis with ciprofloxacin. Prevalence of FQRE digestive carriage and risk factors were investigated. Incidence of infectious complications after (TRUS-BP) in each group was compared.

RESULTS

G2 included 80 patients versus 77 in G1. There was no difference between the two groups regarding age, diabetes, prostate volume, PSA, number of biopsy cores, and risk factors for FQRE. In G2, the prevalence of FQRE digestive carriage was 56.3% all related to E. coli species. In the case of digestive carriage of FQRE, TAP according to the rectal swab culture with third-generation cephalosporins was performed in 73.3%. Patients with FQRE had history of FQ use within the last 6 months in 17.8% (p = 0.03). Rate of febrile urinary tract infection after PB was 13% in G1 and 3.8% in G2 (p = 0.02).

CONCLUSIONS

Incidence of FQ resistance in the intestinal flora of our local population was prevalent. Risk factor for resistance was the use of FQ within the last 6 months. TAP adapted to rectal swab, mainly with third-generation cephalosporins, significantly reduced the rate of infectious complications after (TRUS-BP).

Diffuse Kaposi sarcoma with oral involvement in a person diagnosed with human immunodeficiency virus/acquired immune deficiency syndrome: A case report

Kaposi's sarcoma is a well-known multifocal vascular tumor initially described by pathologist Moritz Kaposi. This report presents the case of a 38-year-old bisexual male who consulted the infectious diseases department with non-itchy maculopapular and purpuric lesions on the skin with the involvement of the oral mucosa, suggesting a diagnosis of Kaposi's sarcoma. Biological and radiological investigations were performed. The patient was found to be human immunodeficiency virus positive with a viral load of 251.000/mL and a CD4 count of 182/mm3. In addition, secondary syphilis was diagnosed. Histopathological examinations confirmed HHV-8 KS. The patient was treated with Extencilline® and antiretroviral therapy. After 10 months of chemotherapy, a favorable outcome was noted with complete resolution of skin and oral mucosa lesions.

Salivary biochemical parameters in people living with HIV on ART and dental caries: a cross-sectional study in Monastir, Tunisia

BACKGROUND

Studies regarding salivary biochemical parameters and dental caries in adult people living with HIV/AIDS (PLWHA) are scanty.

AIM

To investigate salivary biochemical parameters and dental caries in adult PLWHA who are on antiretroviral therapy (ART) and compare the findings with people negative for HIV infection.

METHODS

The study included 50 HIV positive individuals as a test group (TG) and 50 HIV negative individuals as a control group (CG). Dental examination was performed according to WHO guidelines to assess DMFT. Digital panoramic radiographs were taken to detect additional infectious foci. Non-stimulated saliva was collected between 9 and 12 a. m for 5 min to evaluate 18 biochemical parameters and salivary flow rate (SFR). Parametric and non parametric tests were used according to data distribution. The level of significance was set at p < 0.05%.

RESULTS

Patients' mean ages and M/F sex ratios for TG and CG were 38.80 ± 9.69 y/o. vs. 37.98 ± 13.47 y/o. and 3.54 vs. 2.33, respectively. Higher means of decayed teeth were recorded in TG, 4.47 ± 3.00 vs. 3.88 ± 2.81 in CG with no significant difference (p = 0.41). Means of filled teeth were significantly lower in TG 2.38 ± 2.16 vs. 4.16 ± 3.35 in CG (p = 0.01), respectively. No statistical significant difference was noted in DMFT indices between the 2 groups (8.04 ± 6.90 vs. 8.52 ± 6.24, p = 0.71). The following salivary parameters were significantly lower in TG compared to CG, respectively: mean SFR 0.44 ± 0.18 ml/min vs. 0.61 ± 0.26 ml/min; median levels of sodium and chlorides, 4 mmol/L and 13.5 mmol/L vs. 9 mmol/L and 19 mmol/L (p < 0.001) and uric acid, 103.50 mmol/L vs. 163 (p = 0.009). However, higher median levels were recorded with calcium, 1.09 mmol/L vs. 0.54 (p < 0.001) and sIgA 23 mg/dl vs. 5 mg/dl (p < 0.001). In TG, a positive correlation was found between DC, potassium, urea, and chlorides (p < 0.05). Salivary renal and hepatic biomarkers were comparable between the two groups.

CONCLUSIONS

PLWHA have shown an alteration in some salivary parameters, more decayed teeth and less filled teeth. Preventive measures should be implemented to lower dental caries and enhance accessibility to oral care services. In addition, saliva can be utilized to monitor oral and general health status among PLWHA on ART.

Prevalence of comorbid asthma in Tunisian patients with COVID-19: clinical features and outcomes

INTRODUCTION

The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has resulted in around 1 million COVID-19 infection cases and over 29,000 deaths in Tunisia thus far. There is great variability in the prevalence of asthma among patients with COVID-19, but the impact of asthma on patients with COVID-19 is not clear. We sought to describe the clinical features of Tunisian patients with COVID-19 and to compare asthmatic and non-asthmatic patients.

METHODOLOGY

This retrospective study included 675 Tunisian patients who were hospitalized with COVID-19. Clinical characteristics were collected from medical records. Bivariate analyses and multivariate regression models were used to assess the associations between asthma and the risk of severe symptoms, including death/recovery.

RESULTS

The prevalence of asthma in the sample was 14.5%. The results show that asthmatic patients with COVID-19 have significantly less severe symptoms and better outcomes than non-asthmatic patients.

CONCLUSIONS

Asthma was not found to be associated with higher severity or worse prognosis among patients with COVID-19 in Tunisia.

Quality of Life of People Living with HIV on Antiretroviral Therapy: A Cross-Sectional Study in Monastir, Tunisia

Introduction

Despite the benefits of an efficient antiretroviral therapy (ART), HIV/AIDS epidemic still represents the most seriousaffection worldwide that negatively impacts people's quality of life (QoL). As no studies exist on QoL in Tunisia, the aim of the present work was i: to assess, based on WHOQOL-HIV BREF tool, the perception of QoL of people living with HIV (PLHIV) receiving ART and ii: to investigate the relationship between socio-demographic features, disease-related variables and QoL domains' mean scores.

Methods

This cross-sectional study was conducted at the department of infectious diseases of F. Bourguiba Teaching Hospital in Monastir, Tunisia. One hundred and five participants receiving ART were involved. QoL assessment was based on the WHOQOL-HIV Bref including six domains with 29 items with scores ranged from the lowest (4) to the highest (20). Results were reported as frequencies and means (±SD). The Student's t-test for independent samples and the one-way ANOVA were performed to assess differences in QoL mean scores. Linear regression analysis was used to investigate predictors of QoL. The confidence interval was set at 95%.

Results

Clients' mean age was 39.20±10.18 years old with a male to female sex ratio of 3.12. Low mean scores were seen with the environment (12.34±2.90), social relations (12.58±3.94) and psychological domains (12.76±3.31), and moderate mean scores were noted for the physical (14.11±3.52), the spiritual (14.05±3.78) and the level of independence (13.98±3.57) domains. Regression analysis showed that health status and feeling healthy were related to all QoL domains and that profession, marital status and the presence of a confident person were related to environment and spiritual domains.

Conclusion

QoL of PLHIV on ART is affected. Concrete measures and strategies should be undertaken by healthcare stakeholders to improve QoL determinants.

Squamous and glandular metaplasia related to a renal pelvis stone leading to secondary pyeloureteral junction syndrome

Keratinizing squamous metaplasia of the renal pelvis is a rare lesion of the upper urinary tract that can occur in the context of chronic aggression to the urothelium, potentially leading to a secondary pyeloureteral junction syndrome. We report the case of a 43-year-old patient discovered intraoperatively in relation to a renal pelvis stone causing a pyeloureteral junction syndrome. The extemporaneous histological examination ruled out a malignant process, and we performed a pyeloplasty according to KUSS-ANDERSON technique. This pathology should be recognized by the urologist for appropriate management. Treatment is conservative, with extended follow-up to detect recurrences or carcinomatous degenerations.

Checklist for studies of HIV drug resistance prevalence or incidence: rationale and recommended use

HIV drug resistance (HIVDR) is a major challenge to the effectiveness of antiretroviral therapy. Global efforts in addressing HIVDR require clear, transparent, and replicable reporting in HIVDR studies. We describe the rationale and recommended use of a checklist that should be included in reports of HIVDR incidence and prevalence. After preliminary consultations with experts on HIVDR and establishing the need for guidance on HIVDR reporting, we used a sequential, explanatory, mixed methods approach to create the checklist; together with the accompanying articles, the checklist was reviewed by the authors and validated externally. The checklist for studies on HIVDR prevalence or incidence (CEDRIC-HIV) includes 15 recommended items that would enhance transparency and facilitate interpretation, comparability, and replicability of HIVDR studies. CEDRIC-HIV will help authors of HIVDR studies prepare research reports and assist reviewers and editors in assessments of completeness of reporting. The checklist will also facilitate statistical pooling and interpretation of HIVDR data.

A juxtaglomerular cell tumor revealed by a hemorrhagic stroke. A case report

With about 110 cases reported in literature, juxtaglomerular cell tumors are rare. We report a 25 years old patient who was admitted in neurology for a hemorrhagic stroke secondary to a cerebral aneurysm rupture due to high blood pressure. Etiological investigations showed a solid mass of the left kidney. A radical nephrectomy was realized and pathological examination and immunohistochemical profile concluded to juxtaglomerular cell tumor. The originality of this observation is based on the mode of presentation of a rare renal tumor by a malignant high blood pressure.

Informing a target product profile for rapid tests to identify HBV-infected pregnant women with high viral loads: a discrete choice experiment with African healthcare workers

BACKGROUND

Elimination of mother-to-child transmission of hepatitis B virus (HBV) requires infant immunoprophylaxis and antiviral prophylaxis for pregnant women with high viral loads. Since real-time polymerase chain reaction (RT-PCR), a gold standard for assessing antiviral eligibility, is neither accessible nor affordable for women living in low-income and middle-income countries (LMICs), rapid diagnostic tests (RDTs) detecting alternative HBV markers may be needed. To inform future development of the target product profile (TPP) for RDTs to identify highly viremic women, we used a discrete choice experiment (DCE) and elicited preference and trade-off of healthcare workers (HCW) in Africa between the following four attributes of fictional RDTs: price, time-to-result, diagnostic sensitivity, and specificity.

METHODS

Through an online questionnaire survey, we asked participants to indicate their preferred test from a set of two RDTs in seven choice tasks with varying levels of the four attributes. We used mixed multinomial logit models to quantify the utility gain or loss generated by each attribute. We attempted to define minimal and optimal criteria for test attributes that can satisfy ≥ 70% and ≥ 90% of HCWs, respectively, as an alternative to RT-PCR.

RESULTS

A total of 555 HCWs from 41 African countries participated. Increases in sensitivity and specificity generated significant utility and increases in cost and time-to-result generated significant disutility. The size of the coefficients for the highest attribute levels relative to the reference levels were in the following order: sensitivity (β = 3.749), cost (β = -2.550), specificity (β = 1.134), and time-to-result (β = -0.284). Doctors cared most about test sensitivity, while public health practitioners cared about cost and midwives about time-to-result. For an RDT with 95% specificity, costing 1 US$, and yielding results in 20 min, the minimally acceptable test sensitivity would be 82.5% and the optimally acceptable sensitivity would be 87.5%.

CONCLUSIONS

African HCWs would prefer an RDT with the following order of priority: higher sensitivity, lower cost, higher specificity, and shorter time-to-result. The development and optimization of RDTs that can meet the criteria are urgently needed to scale up the prevention of HBV mother-to-child transmission in LMICs.

Paratesticular leiomyoma: A case report of a rare entity

Paratesticular leiomyoma is an extremely rare benign tumour. It is often asymptomatic. It is sometimes difficult to distinguish leiomyomas from malignant testicular tumours, which leads to radical orchidectomy, despite its benign nature. Magnetic resonance imaging can be helpful to make conservative management of this lesion.

Prostate adenocarcinoma metastasis to the testis: A new case report

Prostate cancer (PCa) in the second most common cancer in men worldwide. It commonly metastasizes to the bone, lymph nodes, liver and lungs. Synchronous or metachronous testicular metastasis is a rare finding, generally diagnosed incidentally after bilateral orchidectomy for hormonal management in patients with advanced PCa, or at autopsy. We report a case of a 55-year-old male, presenting a PCa and who developed a single testicular metastasis treated by radical orchidectomy, while he was under hormonotherapy.

Accelerating the prevention, control and elimination of communicable diseases through integration and optimization of the support from Gavi and Global Fund: A vision for the Eastern Mediterranean Region

Over the years, the Eastern Mediterranean Region (EMR) has faced a funding gap with respect to malaria, tuberculosis (TB), HIV, and vaccine-preventable diseases programmes. In the early 2000s, Gavi, the Vaccine Alliance (Gavi) and the Global Fund against AIDS, TB and Malaria (GFATM) became important financial contributors to these programmes. In 2000-2015, funding support from these two global health initiatives allowed progress. However, from 2015, coverage of interventions plateaued, and the region is now behind on the related Sustainable Development Goal (SDG) targets.

COVID-19 vaccine acceptance and associated factors among people living with HIV in the Middle East and North Africa region

Background

Identifying coronavirus disease 2019 (COVID-19) vaccine acceptance and associated factors among people living with HIV (PLHIV) in the Middle East and North Africa region is important to meet the need for broad-scale vaccination against COVID-19.

Objectives

To investigate the COVID-19 vaccine acceptance rate and factors among PLHIV in the Middle East and North Africa region.

Method

An online cross-sectional survey was conducted among PLHIV currently living in Egypt, Tunisia and Saudi Arabia between March 2021 and August 2021.

Results

Of the 540 respondents, 19.3% reported already being vaccinated against COVID-19 (n = 104), 32.0% responded ‘definitely yes’ (n = 173), and 13.3% responded ‘probably yes’ (n = 72) for intention to receive a COVID-19 vaccine, with an overall COVID-19 vaccine acceptance rate of 64.6% among PLHIV in the region. The most significant predictors of COVID-19 vaccine acceptance included feeling less worried about COVID-19 transmission post-vaccination (221.0% higher odds), and believing the disease is vaccine-preventable (160.0% higher odds). Reported barriers to COVID-19 vaccine acceptance include concerns about vaccine effectiveness and belief that HIV medications protect against COVID-19 transmission, living in a rural area and reporting less-frequent engagement with HIV care. Nine out of 10 participants reported that the chances of them getting COVID-19 vaccine would increase if given adequate information and if their doctor recommended it.

Conclusion

Findings of the study can help researchers, health officials, and other health system actors understand the predictors and barriers to COVID-19 vaccine acceptance reported by PLHIV. This understanding could inform the future planning of interventions tailored to PLHIV.

Trends in Adult and Elderly Vaccination: Focus on Vaccination Practices in Tunisia and Morocco

Vaccine preventable diseases (VPDs) are a prevailing concern among the adult population, despite availability of vaccines. Unlike pediatric vaccination programs, adult vaccination programs lack the required reach, initiative, and awareness. Clinical studies and real-world data have proven that vaccines effectively reduce the disease burden of VPDs and increase life expectancy. In Tunisia and Morocco, the national immunization program (NIP) focuses more on pediatric vaccination and have limited vaccination programs for adults. However, some vaccination campaigns targeting adults are organized. For example, influenza vaccination campaigns prioritizing at risk adults which includes healthcare professionals, elderly, and patients with comorbidities. Women of childbearing age who have never been vaccinated or whose information is uncertain are recommended to receive tetanus vaccination. Tunisia NIP recommends rubella vaccine mainly for women of childbearing age, while in Morocco, national vaccination campaigns were organized for girls and women (up to 24 years of age) to eliminate rubella. Further, travelers from both countries are recommended to follow all requirements and recommendations in the travel destination. The objective of this manuscript is to provide an overview of the global disease burden of common VPDs including (but not limited to) meningococcal diseases, pneumococcal diseases, hepatitis, and influenza. The review also provides an overview of clinical data and guidelines/recommendations on adult vaccination practices, with special focus on Tunisia and Morocco. Some European and North American countries have concrete recommendations and strategies for adult vaccination to keep the VPDs in check. In Morocco and Tunisia, although, there are sporadic adult vaccination initiatives, the efforts still need upscaling and endorsements to boost vaccination awareness and uptake. There is a need to strengthen strategies in both countries to understand the disease burden and spread awareness. Additional studies are needed to generate economic evidence to support cost-effectiveness of vaccines. Integration of private and public healthcare systems may further improve vaccination uptake in adults.

Upper urinary tract urothelial carcinoma diagnosis by biopsy of a vaginal metastasis

Upper tract urothelial carcinoma presents 5% of urothelial cancers. The most frequent revealing symptom gross haematuria. Vaginal metastasis is rare revealing condition. The combination on these two symptoms should recall the diagnosis of this neoplasm. Biopsy of the vaginal mass can make the histologic diagnosis easily.

Impact de la COVID-19 sur la formation des résidents en Maladies Infectieuses

Introduction

Les résidents en Maladies Infectieuses sont depuis 2020 parmi les médecins de première ligne dans la prise en charge des patients présentant une infection par le SARS-CoV-2. Toutefois, aucune étude ne s'est intéressée à l'impact de la pandémie sur leur formation.

Matériels et méthodes

Il s'agissait d'une étude transversale menée dans le service des Maladies Infectieuses durant la période (1^er Novembre-31 décembre 2021). Un questionnaire était envoyé aux résidents via Google forms comportant des questions sur la formation en Maladies Infectieuses durant la pandémie de la COVID-19. Les questionnaires étaient envoyés par e-mail.

Résultats

Quarante-cinq questionnaires étaient envoyés durant la période de l'étude et 34 résidents (75,5 %) avaient répondu. L'âge moyen était 29,7 ans ± 2,7 ans (26-36 ans) et le sex ratio (H/F) était à 0,13. Durant l'année 2020, l'effectif comptait 30 résidents participants et durant l'année 2021, 34 résidents. Le contact avec les patients ayant la COVID-19 était jugé fréquent chez 12 résidents (40 %) au cours du 1^er semestre de l'année 2020 et 21 résidents (61,7 %) au cours du 2^ème semestre de la même année. Vingt-huit participants avaient répondu que le premier semestre de l'année 2020 comme étant le plus stressant (n=28, 93,3 %). L'activité clinique habituelle était jugée diminuée pour 24 résidents (80 %) durant le 1^er semestre de l'année 2020 et pour 18 résidents (53 %) durant le 1^er semestre de l'année 2021.La formation des résidents dans les services hospitaliers (Staffs, visites au lits des malades) était jugée diminuée durant toute l'année 2020. La formation extra-hospitalière (DIU, congrès, cours de collège et l'auto-apprentissage) avait diminuée durant les quatre semestres. En effet, la participation aux cours de collège avait diminuée, au cours du 1^er semestre de 2020, pour 19 résidents (63,3 %) et arrêtée pour 8 (26,6 %). Cette activité était touchée au cours du 1^er semestre de l'année 2021 avec une diminution de la participation pour 17 résidents (50 %). Cependant, elle était arrêtée uniquement pour un seul résident (2.9 %). Le recours à la formation virtuelle était plus important pour les DIU durant le 2^ème semestre de l'année 2020 (53,3 %) et le 1^er semestre de l'année 2021 (44,1 %). Les obstacles à la formation chez les résidents étaient essentiellement : l'impact psychologique de la pandémie (n=26, 76,5 %) et la suspension des activités habituelles (n=23, 67,6 %). Pour améliorer leur formation, les participants avaient proposé de partager l'activité COVID-19 avec les autres spécialités (n=23, 67,6 %) et de renforcer la formation en ligne (18, 52,9 %).

Conclusion

L'impact de la pandémie sur la formation des résidents en Maladies Infectieuses était important. Nous devons tirer des leçons de cette pandémie et améliorer les conditions du travail des résidents pour garantir une formation équitable et suffisante. L'élaboration d'un portfolio pour les résidents en Maladies Infectieuses devient une urgence afin de rattraper le retard et de parfaire rapidement leur formation.

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[A longitudinal study about post-traumatic stress disorder after delivery in Tunisian primiparous]

OBJECTIVES

The aims of this study were to estimate the incidence of the post-partum post-traumatic stress disorder (PP-PTSD) in primiparous women, and to determine the profile of women at risk of developing this disorder.

METHODS

We conducted a descriptive, prospective and longitudinal study carried out at the maternity department of the Hedi Chaker Hospital, Sfax-Tunisia over a period of 15 months. At the first stage of the study, the Saint-Antoine pain questionnaire, the peri-traumatic dissociative experiences questionnaire and the peri-traumatic distress inventory were used respectively to assess the pain of delivery, the peri-traumatic dissociation and distress. At the second stage of the study, the questionnaires, perinatal post-traumatic stress disorder (PPQ), hospital anxiety and depression scale and the Edinburgh postnatal depression scale were used respectively for the PP-PTSD screening and the assessment of the post-partum anxious and depressive symptomatology.

RESULTS

The study population consisted of 183 parturients at the first stage of the study and 150 parturients at the second stage of the study. The incidence of the PP-PTSD was 9.3 %. In the multivariate study, some factors studied were significantly associated with the development of PTSD-PP, including a history of therapeutic termination of pregnancy, a history of miscarriage, exposure to a stressful event during pregnancy, prenatal hospitalization of the mother, instrumental delivery, pain intensity especially in the affective component, peri-traumatic dissociation and avoidance of sexual intercourse for fear of a new pregnancy. However the skin to skin contact with the new-born immediately after delivery was a significant protective factor.

CONCLUSION

The psychological consequences associated with the first birth, particularly the PP-PTSD, are common. The Identification of women at risk and a systematic screening of postpartum post-traumatic stress symptoms are desirable.

The evolving challenges confronting adults living with HIV in three North African countries during the COVID-19 crisis: a survey-based study

BACKGROUND

Coronavirus disease 2019 (COVID-19) has resulted in a huge burden on healthcare systems, especially on programs for chronic illnesses such as HIV. We aimed to assess the challenges confronting adult people living with HIV (PLHIV) in three countries in North Africa during the COVID-19 crisis and their awareness of COVID-19 non-pharmaceutical preventive measures.

METHODS

This online survey included PLHIV aged ≥18 y from three countries in North Africa recruited by a snowball sampling technique, who were asked to complete a modified questionnaire originally developed by the University of Antwerp in Belgium, which was then disseminated through social media tools to assess the study outcomes.

RESULTS

Out of 369 respondents, 260 (70.5%) were males and 237 (64.2%) were aged 18-39 y. Adherence to COVID-19 preventive measures, wearing facemasks (308 [83.2%]), applying hand-sanitizers (299 [80.8%]) and following cough etiquette (261 [70.5%]), were predominantly reported. Only 48 (13%) were vaccinated against influenza. One hundred and forty-five participants (42%) experienced flu-like symptoms, 29 (20%) were tested for COVID-19, with only one confirmed case identified. Among 344 (93.2%) on antiretroviral therapy (73.8% efavirenz- vs 6.4% dolutegravir-based regimens), 219 (63.7%) attended their scheduled visits, 144 (41.9%) had limited access to care due to lockdown and 29 (8.4%) became less adherent to their antiretroviral therapy. Covariates associated with challenges during access to care were age ≥60 y (OR=6.5; 95% CI 1.8 to 23.2) and receiving second-line HIV treatment such as protease inhibitors (OR=2.7; 95% CI 1.3 to 5.8).

CONCLUSION

The pandemic adversely affected PLHIV. New innovative strategies should be implemented to ensure the continuity of HIV services.

Particularités de l’infection à coronavirus chez les patients diabétiques

Objectif

Décrire les caractéristiques épidémio-cliniques, radiologiques et thérapeutiques de l’infection au SARS-COV2 chez les diabétiques.

Matériels et méthodes

Étude rétrospective portant sur les malades diabétiques hospitalisés au service des maladies infectieuses pour une infection à coronavirus durant la période (2020–2021).

Résultats

On a colligé 95 malades diabétiques parmi les 224 malades hospitalisés pour une infection SARS-cov2 (42,4 %). Ils étaient âgés en moyenne de 64 ans (32 ans–86 ans) avec une prédominance masculine (sex-ratio = 1,26). Quatre-vingt-douze malades (96,8 %) avaient un diabète de type 2 dont 18 étaient insulinonécessitants.

Les manifestations cliniques étaient dominées par les arthromyalgies (n = 82, 86,3 %), la toux sèche (n = 55, 57,9 %) et la fièvre (n = 41, 43,1 %). Deux patients (2,1 %) présentaient une douleur thoracique secondaire à une embolie pulmonaire et un syndrome coronarien aigu. La dyspnée était le maître symptôme observé dans 94,7 % des cas, apparue dans un délai moyen de 8,6 jours. Une tomodensitométrie thoracique réalisée chez 52 malades (54,7 %), montrait une atteinte minime (< 10 %) dans 3,85 % des cas, modérée (10–25 %) et étendue (25–50 %) dans 25 % chacune, sévère (50–75 %) dans 36,5 % et critique (> 75 %) dans 9,6 % des cas. Tous les malades bénéficiaient d’une anticoagulation et 92 malades (96,8 %) d’une oxygénothérapie associée à la corticothérapie dans 91,6 % des cas. L’évolution était favorable dans 87,4 % des cas. Douze malades (12,6 %) étaient transférés à l’unité des soins intensifs.

Discussion

Dans notre étude, la moitié des malades diabétiques ont présenté une atteinte pulmonaire de plus de 50 %. Une prise en charge précoce et adaptée serait essentielle pour améliorer le pronostic.

Cerebral nocardiosis with osteomyelitis of skull vault complicating a primary neck lesion in an immunocompetent patient: a case report

Nocardia infection is an uncommon and rare condition in immunocompetent patient. A case of cutaneous nocardiosis complicated with osteomyelitis of the vault scalp in a 64-year-old man, with no remarkable past medical history, is reported. Treatment with trimethoprime-sulfamethoxazole than doxycycline for 12 months led to complete resolution and no evidence of recurrence was noted. Nocardia infection should be considered even in immunocomptent patients and doxycycline is a good alternative for treatment.

Maladie à Coronavirus (COVID-19) : connaissance, attitude et pratiques du personnel de santé

Introduction

La pandémie de la maladie à coronavirus (COVID-19) a provoqué une crise sanitaire majeure. Le personnel de santé est en première ligne de la gestion de cette pandémie. L’étude vise à déterminer les connaissances, les attitudes et les pratiques du personnel de santé (PS).

Matériels et méthodes

Une étude transversale a été entreprise parmi le PS de février à mars 2021. L’étude a évalué les connaissances, l’attitude et les pratiques à l’aide d’un questionnaire auto-administré en ligne (Google formulaire) par e-mail et sur des plateformes de réseaux sociaux.

Résultats

Un total de 100 PS avaient participé à l’étude dont 84 % d’entre eux avaient un âge entre 18 et 29 ans et 79 % étaient des femmes. La majorité d’entre eux étaient des médecins ou des médecins en formations (79 %). Cinquante-cinq participants déclaraient ne pas avoir participé à des formations sur la prévention et le contrôle des infections par le SRAS-CoV-2. Les participants disposaient de connaissances satisfaisantes sur la COVID-19 avec 72 % de taux de réponses correctes sur : l’agent causal, le mode de transmission, la période d’incubation, les signes cliniques, la confirmation diagnostique et les mesures de prévention. Quatre-vingt-cinq participants avaient de bonnes pratiques contre l’infection par le SRAS-CoV-2. Une grande majorité des professionnels de la santé prenaient les mesures de précaution adéquates telles que l’utilisation d’un désinfectant pour les mains (78 %), le port des équipements de protection individuelle (94 %), les enlever soigneusement et les jeter au bon endroit (77 %) et procéder à l’isolement des patients suspects ou confirmés (92 %).

Conclusion

Cette étude a montré que le personnel de santé avait des connaissances suffisantes et une attitude positive envers la COVID-19. La diffusion continue d’informations sur la prévention de la propagation de la COVID-19 à tous le personnel de santé renforcera sa lutte contre ce virus. Les autorités sanitaires et les décideurs doivent fournir les ressources nécessaires pour le permettre de travailler dans un environnement sûr.

Gastrointestinal manifestations of human immunodeficiency virus and coronavirus disease 2019: Understanding the intersecting regions between the two epidemics

In March 2020, the World Health Organization declared coronavirus disease (COVID-19) a pandemic. As of February 2021, there were 107 million COVID-19 cases worldwide. As a comparison, there are approximately 38 million people living with human immunodeficiency virus (PLHIV) worldwide. The coexistence of both epidemics, and the syndemic effect of both viruses could lead to a delirious impact both at individual and community levels. Many intersecting points were found between severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the causative agent of COVID-19, and HIV; among which, gastrointestinal (GI) manifestations are the most notable.

GI manifestations represent a common clinical presentation in both HIV and SARS-CoV-2. The emergence of GI symptoms as a result of SARS-CoV-2 infection provides a new dynamic to COVID-19 diagnosis, management, and infection control measures, and adds an additional diagnostic challenge in case of coinfection with HIV. The presence of GI manifestations in PLHIV during the COVID-19 pandemic could be referred to HIV enteropathy, presence of opportunistic infection, adverse effect of antiretrovirals, or coinfection with COVID-19. Thus, it is important to exclude SARS-CoV-2 in patients who present with new-onset GI manifestations, especially in PLHIV, to avoid the risk of disease transmission during endoscopic interventions.

Structural similarities between both viruses adds a valuable intersecting point, which has mutual benefits in the management of both viruses. These similarities led to the hypothesis that antiretrovirals such as lopinavir/Rironavir have a role in the management of COVID-19, which was the target of our search strategy using the available evidence. These similarities may also facilitate the development of an efficient HIV vaccine in the future using the advances in COVID-19 vaccine development.

Post-traumatic stress disorder and stroke in the elderly

Introduction

Posttraumatic stress disorder (PTSD) is common in survivors of acute life-threatening illness, but little is known about the burden of PTSD in survivors of stroke attack.

Objectives

This study estimated the prevalence of PTSD in post-stroke in the elderly and to look for the factors which are correlated with it.

Methods

Participants were outpatients of Psychiatry B department in Hedi chaker University Hospital Center in Tunisia, over the age of 65, hospitalized in psychiatry for a major depressive episode, recruted between 2000 and 2015. The data was collected using a pre-established sheet containing socio-demographic information, the clinical and evolutionary characteristics of the depressive episode and the therapeutic data concerning the depressive episode.

Results

30 patients were included in this study with an average age (69 Y) and sex ratio (0.66). More than half (53.3%, 16 patients) had a history of chronic somatic disease. The average length of hospitalization was 26 days. The most frequent reason for hospitalization is sadness of mood (43.3%) with cognitive impairment as the predominant clinical symptomatology (40%). 93.3% of the population received as treatment an antidepressant mainly Fluoxetine (50%).

Conclusions

clinicians should be mindful that PTSD can be a devastating mental health condition and should consider screening for PTSD in stroke survivors.

[Metabolic syndrome among people with HIV in central Tunisia: Prevalence and associated factors]

INTRODUCTION

Metabolic abnormalities are frequently reported in HIV infection. They were mainly related to the chronic infection and the use of antiretroviral therapy.

OBJECTIVE

Describe the epidemiological, clinical, laboratory and treatment features of people living with HIV (PLHIV) on antiretroviral therapy and determine the prevalence of metabolic syndrome and its associated factors.

MATERIALS AND METHODS

We conducted a cross-sectional, descriptive and analytical study in the service of Infectious Diseases of the University Hospital of Monastir. We included all PLHIV on antiretroviral therapy for at least 3 months. Biological explorations based on metabolic parameters were performed systematically for all patients after informed consent. Metabolic syndrome was assessed according to the definitions of the International Diabetes Federation (IDF) in 2005. We divided the patients into two groups: Group A: PLHIV with metabolic syndrome (n=19) and Group B: PLHIV without metabolic syndrome (n=51).

RESULTS

We included in this study 70 PLVIH. The metabolic syndrome was noted in 19 cases (27.1%). The average age was 43.7 years in group A and 36.7 years in group B. Gender distribution were uniform in the two groups (P=0.4). HIV infection has been evolving for 9.7 and 5.8 years respectively in group A and B, P=0.017. Body mass index (BMI) was significantly higher in group A (26.4 vs 23.5kg/m², P=0.008). Two patients in group A (10.5%) and 14 patients in group B (27.4%) had a low CD4 count (<200/mm³). Protease inhibitor regimens were prescribed in five cases (26.3%) in group A and 26 cases (50.9%) in group B. In multivariate models, Age over 40 (OR=9.9, 95% CI 2.4-40.6, P=0.001) and BMI ≥25 Kg/m² (OR=8.47, 95% CI 1.94-36.8, p=0.004) were both independently associated with the presence of the metabolic syndrome.

CONCLUSION

Metabolic syndrome is common among PLHIV on antiretroviral therapy. The identification of factors associated is a main parameter for early detection of metabolic risk and personalized management.

[Off label uses of tigecycline]

INTRODUCTION

Tigecycline is a relatively new antibiotic that have very limited valid indications. When no other alternative is available, this drug is widely used off label with promising results. The objective of this study is to summarize the different off label uses of tigecycline so that we can decide when and how to prescribe it in the absence of guidelines.

MATERIAL AND METHODS

This study a revue of the literature collecting all the articles concerning the off label uses of tigecycline.

RESULTS

Tigecycline was widely prescribed, off label, to treat infections with controversial results. Randomised clinical trials were conducted to evaluate its use to treat pneumonia. The results for this indication have a respectable level of evidence. For the other indications, the data collected was insufficient to support tigecycline prescription. In fact, different protocols were used which makes it hard to evaluate the efficacy and to conclude to the best treatment regimen. A tendency to prescribe high doses of the molecule was noted in different studies. When prescribed off label, tigecycline prescriptions were associated with a higher mortality and incidence of side effects.

CONCLUSION

The tigecycline remains a valid option for the treatment of infections dues to multi-resistant bacteria especially when other alternatives are scarce or in cases of renal failure.

A cadaveric anatomical study of the adrenals: Relationship with the posterior abdominal wall muscles revisited

AIM OF THE STUDY

The main difficulties during retroperitoneal laparoscopic adrenalectomies are due to its location. Our objective was to define the relationship of the adrenals with the diaphragm and the psoas muscle.

METHODS

Our work is an anatomical dissection of 80 fresh cadavers' adrenals. To study the right adrenal, we performed a right nephrectomy and adrenal remained attached to the Inferior vena cava by its main vein. On the left, the edges of the adrenal have been identified by needles and the adrenal was reclined to study its projection on the posterior muscular wall.

RESULTS

The right adrenal is located higher, 13mm [4-20mm] above the medial arcuate ligament (MAL) in 16 cases (40%). Its lower border was at the same level as the MAL in 18 cases (45%) and 11mm [10-17mm] below the MAL in 6 cases (15%). The posterior support of the right adrenal was the right crus of the diaphragm (Right-CD) in 34 cases (85%) and straddling the Right-CD and the psoas in 6 cases (15%). The study of the relationships of the left adrenal with the MAL showed that the lower edge of the gland was at its same level in 16 cases (40%) and below in 24 cases (60%) by 14mm [8-24mm]. The posterior support of the left adrenal was the left crus of the diaphragm (Left-CD) in 16 cases (40%) and straddling the Left-CD and the psoas in 24 cases (60%).

CONCLUSIONS

Our results showed that the right adrenal is higher. The MAL is an important posterior element to the adrenal gland that could serve as an anatomical landmark to identify the adrenal during laparoscopic adrenalectomy.