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Les allergies respiratoires aux pollens de graminées sont très répandues dans la population générale et le traitement est généralement symptomatique qui reste parfois insuffisant. L'immunothérapie allergénique (ITA) aux 5-graminées est le seul traitement étiologique des rhinites allergiques saisonnières. Étudier l'efficacité des comprimés d'ITA sublinguale aux 5-graminées sur la maladie allergique et décrire les effets indésirables après une année de traitement. Étude prospective, descriptive et évaluative incluant 40 patients ayant une rhinite allergique aux 5-graminées ayant bénéficié d'un traitement par ITA sublinguale et ayant été suivis pendant une année avec évaluation de l'efficacité et de la tolérance pendant la deuxième saison pollinique. L'âge moyen était de 30,9 ± 12,25 ans avec un sex-ratio (H/F) à 0,48. Une conjonctivite allergique était associée dans 70 % et un asthme allergique dans 48 %. Les effets indésirables de l'ITA étaient locaux et locorégionaux, d'intensité faible et de résolution rapide. Une amélioration de la maladie allergique a été notée avec diminution des symptômes et de la charge thérapeutique. Une amélioration de la qualité de vie diurne et nocturne a été rapportée par les patients dans 78 % des cas. L'ITA était significativement plus efficace chez les patients âgés de moins de 30 ans ayant une rhinite allergique et une conjonctivite allergique. L'ITA aux 5-graminées permet, en toute sécurité, la diminution des symptômes allergiques et l'amélioration de la charge thérapeutique et de la qualité de vie des patients. Respiratory allergies to grass pollens are very widespread in the general population and the treatment is generally symptomatic which sometimes remains insufficient. Grass pollen allergen immunotherapy is currently the only etiological treatment of seasonal allergic rhinitis apart from allergenic eviction. The aim was to study the effectiveness of sublingual ITA tablets with 5-grasses on allergic disease and describe the adverse effects after one year of treatment. We conducted a prospective, descriptive and evaluative study including 40 patients suffering from grass pollen allergic rhinitis. A grass pollen sublingual allergen immunotherapy was received and patients were followed during a one-year treatment to study the efficacy and the safety profile. The mean age was 30.9 ± 12.25 years. The sex ratio (M/F) was 0.48. Allergic conjunctivitis was associated in 70% and allergic asthma was associated in 48% of cases. Allergen immunotherapy side effects were mild, consisting of local side effects. No severe side effects were observed. A decrease in allergic rhinitis symptoms was observed in 83% with improvement in medication score in 65%. All patients noted a decrease in conjunctivitis symptoms with a total regression in 54% of cases. A better asthma control was noted in 33%. Among the 19 patients suffering from asthma, we could decrease the drug use in 63% of cases during the first year of treatment. An improvement of the quality of life was observed in 78% of cases. Allergen immunotherapy was significantly more efficient in allergic rhinitis and conjunctivitis with patients under 30 years old. Grass pollen allergen immunotherapy leads safely to the regression of allergy symptoms and improves the therapeutic load and the quality of life. [ABSTRACT FROM AUTHOR]

Il a été observé que plusieurs patients atteints d'une rhinite chronique sans asthme avaient une hyperréactivité bronchique (HRB). Ce qui suggère que la rhinite est un facteur de risque d'asthme. Le but de ce travail était d'étudier la prévalence de l'HRB chez les patients ayant une rhinite et d'évaluer les caractéristiques des patients qui présentent une HRB. Il s'agissait d'une étude prospective, descriptive et analytique, incluant 80 patients rhinitiques et chez qui un test de provocation bronchique à la méthacholine était réalisé. L'âge moyen des patients était de 32 ans avec un sexe ratio H/F à 1,2. Vingt-quatre pour cent étaient des fumeurs quotidiens. Quarante pour cent des patients atteints d'une rhinite chronique avaient une HRB. L'HRB était significativement plus présente chez les patients atteints de rhinite allergique comparativement aux patients atteints de rhinite non allergique (p < 0,001). L'HRB était modérée à sévère (PD20 < 600 μg) dans 40 % des cas et légère (PD20 ≥ 600 μg) dans 60 % des cas. Une HRB a été noté chez 23 % des hommes et chez 18 % des femmes (p = 0,854). Quarante pour cent des patients ayant une rhinite allergique avec une monosensibilisation aux allergènes avaient une HRB contre 11 % pour les polysensibilisés (p = 0,002). Par ailleurs, le type de la sensibilisation (mono ou polysensibilisés) constitue le seul facteur indépendant associé à l'HRB chez les patients ayant une rhinite. Cette étude souligne le lien étroit entre les voies aériennes supérieures et inférieures et le rôle de certains facteurs qui sont plus fréquemment associés à l'HRB, tels que l'origine allergique de la rhinite et le type de sensibilisation. Chronic rhinitis is a real public health problem. Furthermore, it was observed that several patients with chronic rhinitis and without clinical signs of asthma had bronchial hyperreactivity (BHR). This suggests that rhinitis is a risk factor for asthma. The aim of this study was to study the prevalence of BHR in chronic rhinitis and to determine the risk factors for this BHR. This was a cross-sectional, prospective, descriptive and analytical study done in pneumo-allergology department of the military hospital of Tunis, collecting 80 patients with chronic rhinitis and for whom a bronchial provocation test with methacholine was performed. The median age of patients was 32 years with a sex ratio of 1.2. Twenty-four percent were daily smokers. Forty percent of patients with chronic rhinitis had BHR. BHR was more present in patients with allergic rhinitis than patients with non allergic rhinitis (P < 0.001).BHR was moderate to severe (PD20 < 600 μg) in 40% of cases and mild (PD20 ≥ 600 μg) in 60% of cases. A BHR was observed in 23% of men and 18% of women (P = 0.854). Forty percent of patients with allergic rhinitis and monosensitization had BHR versus 11% for polysensitized patients (P = 0.002). Furthermore, the type of sensitization (mono or polysensitized) is the only independent factor associated with HRB in patients with rhinitis. This study highlights the close link between the upper and lower airways and the role of certain factors that are more frequently associated with BHR, such as the allergic origin of rhinitis and the type of sensitization. [ABSTRACT FROM AUTHOR]

Background: Health Care workers (HCWs) are constantly on the front line during the current pandemic, facing a permanent influx of patients with a significant risk of viral contamination. Our study aimed at estimating the corona virus disease high risk perception and evaluating determinant factors of the perceived vulnerability to Covid-19 among HCWs in the region of Mahdia (Tunisia). Methods: We conducted a cross sectional study among HCWs in the University Hospital Tahar Sfar Mahdia in Tunisia in December 2020. The perceived vulnerability to disease was assessed using the validated perceived vulnerability to disease scale (PVDS). Results: A total of 173 professionals were recruited with a mean age of 35.35 ± 9.4 years. Among them, 66% were women. One third of participants (33.3%) were doctors. The majority of them (86%) have experienced a high level of risk perception. The older HCWs (p = 0.04), the nursing personnel (p = 0.02), as well as, those with pre-existing chronic diseases (p = 0.04) perceived greater vulnerability to Covid-19. It was also significantly associated (p = 0.01) with undressing faults. Being older (standardized β = 0.193, CI = 0.601-7.707, p = 0.003), having pre-existing chronic diseases (β = 0.184, CI = 0.478-8.888, p = 0.05), high risk perception (β = 0.162, CI= -0.087-10.47, p = 0.02) and undressing faults (β = 0.224, CI = 0.582-1.306, p = 0.008), were found to be the determinant factors of the perceived vulnerability to disease PVD in a multivariate linear logistic regression model (adjusted R2=0.129). Conclusions: Perceived vulnerability to Covid-19 is mainly manifested by an atmosphere of fear of getting infected, but also by compliance with barrier measures. This fact is aligned with health authorities’s strategies to ensure a society totally free of Covid-19. Key messages: During the current Covid-19 pandemic the majority of health care workers worldwide have experienced a high level of risk perception which negatively impacts their mental health. Health care workers must be provided with the personal protective equipment PPE essential to protect themselves against the Covid-19 transmission. [ABSTRACT FROM AUTHOR]

Introduction: Health workers, as the first line of defence during infectious pandemic, are also one of the main vectors of coronavirus transmission. Preventing the spread of infection to and from caregivers relies on the effectiveness of personal protective equipment (PPE). This study aimed at assessing knowledge, attitudes and practices related to PPE use in a healthcare setting in the region of Mahdia (Tunisia). Methods: A cross-sectional study was carried out on December 2020 among health care professionals (HCP) in the University Hospital Tahar Sfar Mahdia. The measurement tool was developed by specialists at the Department of Preventive Medicine after reviewing literature then pretested. Results: A total of 173 HCP were enrolled with an average age of 35 ± 9.3 years. More than half of participants were females (64.7%), 32.9% were doctors and 34.7% were nurses. Among them, 35.8% have worked during a pandemic before. The level of good knowledge was 52%. The main sources of information for HCP were the Ministry of Health (63.6%), social network and media (58.4%). About 25.4% of HCP was satisfied by the preventive measures training received in the hospital. Half of HCP (54.3%) admitted that their knowledge related to the pandemic was not sufficient. While third of the HCP (31.8%) thought that it is necessary to wear the full PPE, 16.8% knew how to put on their PPE and 27.2% knew how to take it off. Conclusions: Taking into account knowledge, attitudes and practices related to PPE use allows the implementation of a strategy aimed at mastering the management of this equipment by health care workers. Key messages: Assessing the Knowledge, attitudes and practices related to the personal equipment among health care givers: 52%. Implementation of a strategy aimed at mastering the management of this equipment by health care workers. [ABSTRACT FROM AUTHOR]

Subclavian steal syndrome (SCSS) has been known since 1960 in the medical literature. Its principal cause is atherosclerosis responsible of occlusion of the subclavian artery (SCA). It is the pathological process in which blood flows in reverse direction from the vertebral artery (VA) to the SCA. Usually asymptomatic, but a variety of symptoms may develop involving the vertebro-basilar and/or the carotid territories and may be precipitated by exercise of the upper extremity. In some circumstances it can be iatrogenic complicating the course of a thoracic endovascular aortic repair (TEVAR) when the left SCA is covered by the endoprosthesis, which is a necessity many times giving the frequent proximity of the acute thoracic pathologies to the origin of this vessel. We present a case of severe headache occurring after a TEVAR with intentional coverage of the origin of the left SCA. This headache was the only symptom from which the patient complained, and which disappeared immediately after carotid-SCA bypass. Other devastating complications can happen, which gave as a concern about the management of SCA when decision to practice a TEVAR is taken. [ABSTRACT FROM AUTHOR]

Data about the profile and risk factors of premature births in Tunisia are scarce. The objective of this study was to describe the epidemiological profile of preterm births in Monastir, Tunisia, and to study the chronological trends of associated factors over the years 1994-2012. A population-based study was conducted using data from the regional births database on all deliveries in public maternity units. The overall prevalence of preterm births among the 161 116 deliveries in the 19-year period was 5.60% (95% CI: 5.13%-6.07%). The rate of preterm births and of adequate prenatal care increased significantly over the study period. Extremes of maternal age (≤ 19 and ≥ 35 years), having a twin pregnancy and the occurrence of complications during pregnancy were significant predictors of prematurity in the final regression model. Efforts should be made to improve the quality of health care in the region, especially for high-risk pregnancies. [ABSTRACT FROM AUTHOR]

A study in Monastir, Tunisia estimated the prevalence of smoking and analysed the determinants of tobacco use among adolescents aged 10-19 years. An observational cross-sectional study was performed in the 8 colleges and high schools of Monastir city in 2004. The mean age of the 900 respondents was 15.8 (SD 2.2) years and 47.7% were aged under 16 years. The overall prevalence of cigarette use during the past year was 16.0% (30.2% among males and 4.6% among females). The first smoking experience was initiated by friends in 45.8% of cases, at a mean age of 13.8 (SD 2.3) years. One-fifth of smokers (21.5%) had used other forms of tobacco. In multivariate analysis, male sex, academic failure, poor family management, antisocial behaviour and addictive behaviour were the main predictors of adolescent smoking status. The prevalence of smoking among adolescents in Monastir is high and requires targeted action. [ABSTRACT FROM AUTHOR]

This study aimed to estimate the prevalence and risk factors for health-care-associated infection (HAI) in all 9 hospitals of the central-east area of Tunisia in 2005. Of 1373 patients admitted for more than 48 hours, 74 developed HAI, a prevalence of 5.4% (95% CI: 4.2%-6.6%). The prevalence was significantly higher in the intensive care units (18.4%) and neonatal departments (12.7%). There were 79 infections and the most frequent sites of infection were respiratory tract and urinary tract. Microbiological examination was performed for 25 cases of HAI and Pseudomonas aeruginosa was identified in 8 cases. Multiple logistic regression analysis indicated that HAI was linked to diabetes (OR = 2.0), immunosuppression (OR = 3.3), length of stay (OR = 4.5), central venous catheter (OR = 2.5) and peripheral venous catheter (OR = 10.2). We conclude that HAIs are of concern in this area of Tunisia. [ABSTRACT FROM AUTHOR]

Introduction: According to the Health Word Organization (WHO), adverse childhood experiences (ACEs) have several harmful outcomes on mental health in adolescence and later life. We aimed at investigating the relationship between ACEs and risky behaviors among Tunisian health professionals. Methods: A cross sectional study was conducted between November 2018 and March 2019 among health care workers in two University Hospitals in Tunisia. We assessed exposure to violence in the hospital, behavioral (cyberaddiction) and chemical addiction (tobacco and alcohol use). ACEs were screened using the Arabic validated version of the Adverse childhood experiences-International Questionnaire (ACE-IQ) developed by the WHO. Results: A total of 546 health professionals were enrolled with a mean age of 34.5 9.6 years and a majority being female (70%). Almost 34.8% were doctors. The majority of them (67.3%) reported exposure to physical violence at work by patient or their families. The most common hazardous practice was internet addiction (18.5%) followed by tobacco use (13.2%). All health risk behaviors were significantly more prevalent among males and youth (<35 years) (p < 0.01). After adjustment for violence at work and socidemographic characteristics, logistic regression revealed that ACEs especially physical violence (OR = 1.8; IC [1.1-2.9]), emotional abuse (OR = 4.5 [1.2-16.6]) and bullying (OR = 2.6 [1.6-4.2]) increase the risk of the adoption of addictive behaviors among health caregivers. Conclusions: Policy makers might implement collaborative interventions with psychiatrics targeting the prevention of early life adversities, this could be helpful to delay the onset of risky behaviors. Key messages: Exposure to early life adversities increase the risk of addictive behaviors among health caregivers. Collaborative interventions with psychiatrics targeting screening childhood adversities could be helpful to delay the onset of risky behaviours. [ABSTRACT FROM AUTHOR]

Background: Adverse Childhood Experiences (ACEs) have become an alarming phenomenon exposing individuals at a great risk of developing mental health issues. To date, there remains a lack of adequate researches on ACEs especially among adolescents. This survey aimed to describe the prevalence of childhood adversities and to determine their role in developing risky behaviours amongst Tunisian youth. Methods: We conducted a cross sectional study among schooled adolescents in the governorate of Mahdia (Tunisia) from January to February 2020. Exposure to violence was assessed using the validated Arabic version of the WHO ACE questionnaire. The Internet Addiction Test (IAT) and the Hospital Anxiety and Depression scale (HAD) were used as a screening tool for internet addiction, anxiety and depression. Results: A total of 1940 adolescents were recruited. The majority of them (97.5%) reported experiencing at least one ACE. Emotional neglect (83.2%) and witnessing community violence (73.5%) were the most reported ACE categories. According to gender, males had higher rates of exposure to physical abuse and social violence than females. The most common risky behaviour was internet addiction (50%) followed by substance use (16.6%). After adjustment for anxiety and depression, the dose-response association between ACE and risky behaviours was well established. Conclusions: These results among youth have both public health and societal implications. Key messages: The prevalence of exposure to adverse childhood experiences as well as risky behaviors are alarming among Tunisian adolescents. Screening addictive behaviors among youth with a history of childhood adversities is needed. [ABSTRACT FROM AUTHOR]

Background: Several incidents of stigmatization of healthcare workers, COVID-19 patients and their families have come up during the current pandemic across the world. Aim: To evaluate discriminative behaviors against people tested for Covid-19 in the governorate of Mahdia in Tunisia. Methods: We performed a cross sectional study among people tested for Covid-19 from November to December 2020 in the region of Mahdia. Discrimination was assessed using a pretested brief questionnaire inspired from the reliable French version of HIV stigma scale. Trained members of the study team explained the study’s purpose and collected data from each participant via phone calls. Results: A total of 277 participants were recruited with a mean age of 34.32 ±13.7 years. Among them, 60.8% were women and 62.2% were tested positive for Covid-19. Forty three percent of participants were health professionals with 25.3% of them were directly involved in the care of COVID-19 patients. More than half of respondents (61%) have experienced discrimination. Thus, 40% were subjected to verbal and physical assaults. Concerning stigma among health care workers, 60% were doctors and 67.2% have worked in a covid-19 care service. Our survey shows a higher level of Covid-19 related stigma among married respondents and those living with elderly people (46.8% and 43.8% respectively). Discrimination was associated with being a health care professional (p = 0.05), mainly a doctor (p = 0.03) and having COVID-19 infection (p = 0.02). Conclusions: The continued discriminatory and stigmatising attitudes towards people tested for Covid-19 negatively impacts their access to health care services. We recognise a pressing need to improve the knowledge of Covid-19 transmission, and implement universal precautions across all health facilities. Key messages: The high prevalence of discriminatory attitudes against people tested for Covid-19 is alarming. It’s an unpleasant experience causing numerous psychological distresses among those who undergo it. Establishing a positive safety culture and providing appropriate education to reduce the stigma towards infected people offers an effective way to improve the quality of care. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic is causing considerable lifestyle changes through barriers measures, lockdown and social distancing. These changes include: Preoccupation with Covid-19 pandemic news, sleep disturbances and eating habits changes. Aim: To assess the lifestyle changes after exposure to a risk of coronavirus contamination. Methods: We conducted a cross sectional study during November and December 2020 among adults tested for COVID-19 in Mahdia (Tunisia).To assess the life habits changes (sleep, physical exercises and diet), the compliance with barrier measures and preoccupation with COVID-19 pandemic news, a reliable tool was developed and pretested by experts at the department of Preventive and Community Medicine Results: A total of 277 participants were enrolled, the average age was 34.32 years ± 13.7. Among them 60.8% were women (sex-ratio = 0.51).Almost two thirds 62.2% were tested positive for Covid-19. Doctors presented 29.2% of the respondents. Among the study sample, 38.6% lived with elderly people. Approximately three quarters 77.8% reported an improvement in compliance with barrier measures. The majority 92.1% respected more the social distancing. As for hand washing and for mask wearing, 87.7% said to wash their hands more, and 95.3% were more concerned about wearing masks. A life habits change was observed among 16.7% of the respondents. Almost half of the participants 45.5% increased their physical activity, while 76.2% tried to get a healthy diet. Sleep disorders were registered among 48.7% of respondents. Preoccupation with the COVID news was observed in approximately half of the participants (57.8%). Conclusions: The COVID19 pandemic affected different aspects of our lives. Research related to lifestyle, social and behavioral studies are as important as those related to medical and biological science. Key messages: A life habits change was observed among 16.7% of the respondent, sleep disorder were registered among 48.7%, and 77.8% reported and improvement in applying barrier measures. Research related to lifestyle, social and behavioral studies are as important as those related to medical and biological science. [ABSTRACT FROM AUTHOR]

Background: The massive spread of the corona virus being relatively deadly, leads to psychological pressures dominated by an atmosphere of panic and worries mainly among Health Care workers (HCWs). Only few studies have evaluated this impact on HCWs mental health in Tunisia. Aim: we aimed at determining the prevalence of corona virus fear and its associated factors among HCWs in the University Hospital Tahar Sfar Mahdia (Tunisia). Methods: We conducted a cross sectional study among HCWs staff in the University Hospital Tahar Sfar Mahdia which is located in the Central-East part of Tunisia in December 2020. The fear of corona virus disease was assessed using the valid French version of the Fear of Covid-19 Scale (FCV-7). Results: A total of 173 professionals were recruited with a mean age of 35.35 ± 9.31 years. Among them, 66% were women. One third of participants (33.3%) were medical professionals. Almost, 68% have experienced a high level of fear. Our survey showed a significantly higher level of fear among females 70.1% and elderly people 60.8%. It was positively associated (p < 0.05) with anxiety and depression, high risk perception and the responsibility degree of being a virus vector for their loved ones. Anxiety and depression disorders (standardized β = 3.118, CI = 0.545-5.832,p=0.018), high risk perception (β = 3.321,CI = 0.097-6.545, p = 0.044), knowledge about Covid-19 transmission (β = 2.586, CI = 0.439-4.734, p = 0.019), degree of responsibility (β = 3.130, CI = 0.373-5.887, p = 0.026), being a doctor (β = -6.475, CI = -8.785- -4.165, p = 0.001) and Perceived Vulnerability to Disease (β = 0.26,CI = 0.157-0.363, p < 001) were found to be predictive factors of corona virus fear in the linear regression model (Adjusted R2 = 0.374). Conclusions: Authorities should introduce a preventive strategy based on psychological intervention for HCWs to overcome their fear and worries. Key messages: The high prevalence of the fear of Covid-19 among health care workers is alarming. Its impact on mental health cannot be ignored. The health authorities worldwide should not have as objective only the reduction of the transmission, but also the work on individual fears to ensure a society totally free of covid-19. [ABSTRACT FROM AUTHOR]

Background: Little is known about the mechanism by which Adverse childhood experience (ACE) affects adolescent’s engagement in addictive behaviours in the African context. We investigated the role of impulsivity in the link between ACE and behavioural addiction among schooled youth in Tunisia. Methods: We performed a cross sectional study among 1940 schooled adolescents in the region of Mahdia (Tunisia) from January to February 2020. We used the validated Arabic version of the World Health Organization ACE questionnaire. The Barratt Impulsivity Scale as well as the Internet Addiction Test were used as screening tools for impulsivity and internet addiction. Results: A total of 1940 adolescents returned the questionnaires. About 97.5% reported experiencing at least one ACE. We found that ACEs score predict addictive behaviours through impulsiveness (p < 0.001; % mediated = 16.7%). Particularly, intrafamilial ACEs (p < 0.001; % mediation = 27.8%) demonstrated the most mediation by impulsivity followed by exposure to extra-familial ACEs (p < 0.001; % mediation = 10.5%). There were interactions between ACE and impulsivity in terms of their impact on internet addiction (p < 0.001; % mediation = 37.5%). Conclusions: The mediation part of impulsivity in the association between ACE and cyberaddiction is alarming. [ABSTRACT FROM AUTHOR]

Adverse Childhood Experiences (ACEs) are a common public health issue with a variety of consequences, including behavioral addiction such as Internet Addiction (IA). Despite widespread recognition of this issue, the underlying mechanisms are not well studied in recent literature. Additionally, studies have indicated gender disparities in the prevalence and manifestation of ACEs and IA. The objective of this study was to investigate the mediating effect of resilience on the link between ACEs and IA among high-school students according to gender in Mahdia city (Tunisia). We conducted a cross-sectional survey for two months (January- February 2020), among 2520 schooled youth in Mahdia city (Tunisia). The Arabic-language edition of the World Health Organisation ACE questionnaire was used. The validated Arabic versions of the Adolescent Psychological Resilience Scale and the Internet Addiction Test were the screening tools for resilience and IA. Data were analyzed according to gender. The majority of youth (97.5%) were exposed to at least one ACE with the most prevalent being emotional neglect (83.2%). Exposure to extra-familial ACEs was also high reaching 86.9% with higher rates among boys for all types of social violence. Internet addiction was common among students (50%) with higher prevalence for boys (54.4% vs 47.7%for girls, p = 0.006). Resilience scores were86.43 ± 9.7 for girls vs 85.54 ± 9.79 for boys. The current study showed that resilience mediated the link between ACEs, especially intrafamilial violence, and internet addiction (%mediated = 15.1). According to gender, resilience had a significant mediating role on internet addiction for girls (%mediated = 17) and no significant role for boys. The mediating effect of resilience in the relationship between ACEs and cyberaddiction among schooled adolescents in the region of Mahdia (Tunisia) has been identified., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Mlouki et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: In this study, the usefulness of transthoracic echocardiography (TTE) in systematic screening was assessed for various cardiac abnormalities in patients with rheumatoid arthritis (RA)., Methods: We performed a comparative cross-sectional study from July 2020 to February 2021. Each patient underwent a TTE coupled with the strain technique., Results: Seventy-two RA patients and 72 controls were included. Abnormalities detected by TTE were more frequent in RA patients (80.6% vs. 36.1%; p < 0.01), and they were asymptomatic in 65.5% of cases. Valvular involvement was found in 45.8% of RA patients, with a significant difference (p < 0.01). Left ventricular diastolic dysfunction was also more frequent in the RA group (36.1% vs. 13.9%; p < 0.01). Left ventricular systolic dysfunction was absent in our study, but subclinical left ventricular myocardial damage assessed by Global Longitudinal Strain (GLS) method was found in 37.5% of RA patients and 16.6% of controls (p < 0.01). The mean GLS in RA patients was -17.8 ± 2.9 (-22 to -10.7) vs. -19.4 ± 1.9 (-24.7 to -15.7) in controls. Left ventricular hypertrophy was detected in 22.2% of RA patients and in 6.9% of controls (p < 0.01). Pericardial effusion and pulmonary arterial hypertension were present only in the RA group (2.8% of cases). We found a significant relationship between echocardiographic damage and disease activity (p < 0.01), number of painful joints (p < 0.01), functional impact (HAQ) (p = 0.01), CRP level (p < 0.01) and the use and dose of Corticosteroids (p = 0.02; p = 0.01)., Conclusion: Echocardiographic damage in RA is frequent and often asymptomatic, hence there has been an increased interest in systematic screening in order to improve the quality of life and vital prognosis of patients. Early management of RA can reduce the risk of occurrence of cardiac involvement., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Multiple myeloma is a common malignant bone-based disease. Pleural effusions reported in these patients remain rare. It is commonly due to congestive heart disease, pulmonary embolism, nephrotic syndrome or a second neoplasia. The true myelomatous pleural effusion resulting from a direct tumoral invasion of the pleural are extremely rare. We report here the case of a massive pleural effusion revealing multiple myeloma in a 71-year-old patient. The chest ultrasound showed a massive pleural effusion in the left side with a multinodular thickening of the pleura. The medical thoracoscopy showed a grape-cluster appearance. The diagnosis was made by pleural guided biopsy revealing abnormal plasma cells with an intense positive CD 138 (plasma cell marker) and MUM1 (multiple myeloma oncogene1) staining with a light kappa chain in the protein electrophoresis associated with a myeloma. Unfortunately, our patient died one month after the initial diagnosis. We present also a review of the recent literature in order to highlight the clinical presentations of the myelomatous pleural effusion, the diagnostic tools, the therapeutic strategies as well as the outcomes., Competing Interests: No competing interests were disclosed., (Copyright: © 2023 Daboussi S et al.)

Hodgkin's disease with an initial tracheobronchial involvement is not common. The symptoms might be misleading, resulting in a diagnosis delay. We report the case of a 38-year-old woman with a one-month history of wheezing associated with a dry cough. The physical examination revealed a good general state of health, bilateral wheezing and supra-clavicular lymphadenopathy. The adenopathy biopsy's histopathology revealed Hodgkin lymphoma. The whole body FDG-PET scan was an important tool to assess the diagnosis as well as for the staging. The patient was treated with chemotherapy. Another unusual aspect is the tracheobronchial metastasis confirmed by a bronchial biopsy. Thus, our patient was put on a second-line chemotherapy. She died one year after the initial diagnosis. To conclude, it is an atypical clinical presentation of an Hodgkin lymphoma with a tracheobronchial relapse. It should be considered in the differential diagnosis of asthma or a tracheal tumor., Competing Interests: No competing interests were disclosed., (Copyright: © 2023 Daboussi S et al.)

Background: Several studies revealed that medical students have low performance levels of hand hygiene (HH) and biomedical waste management (BMWM). However, there have been limited interventions directed at young students targeting HH and BMWM enhancement. Given these data, we aimed at assessing HH and BMWM among medical students after two training methods., Methods: We performed a quasi-experimental study from September 2021 to May 2022, which included fifth-year medical students enrolled in the faculty of Medicine of Monastir (Tunisia). We relied on a conventional training based on presentations and simulations guided by the teacher and a student-centred training method based on courses and simulated exercises prepared by students. We used the WHO HH Knowledge Questionnaire and the "BMWM audit" validated by The Nosocomial Infection Control Committee in France., Results: A total of 203 medical students were included (105 in the control group and 98 in the experimental group) with a mean age of 23 ± 0.7 years. Regarding HH, we found a statistically significant increase in post-test scores for both training methods. A higher post-test mean score was noted for student-centred method (14.1 ± 1.9 vs. 13.9 ± 2.3). The overall improvement in good HH knowledge rates was greater after student-centred method compared to conventional training (40.5% vs. 25%). Concerning infectious waste, mean scores were higher after student-centred learning in all hazardous waste management steps (25 ± 3.3 vs. 23.6 ± 5.5)., Results: Coupling student-centred teaching and continuous supervision could improve HH and BMWM knowledge and practices among medical students., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Dieulafoy's disease of the bronchus can cause massive and even fatal hemoptysis. Even though it is rare, it should be considered by physicians all over the world. This paper reports a case of bronchial Dieulafoy's disease and summarizes the data of similar cases reported in literature., Methods: We report a case of bronchial Dieulafoy's disease (BDD) in Tunisia. We also present a review of literature related to BDD from 1995 to 2022 using the PubMed, Google Scholar, web of science and Chinese National Knowledge Infrastructure Databases. Clinical characteristics, chest imaging, bronchoscopic and angiographic findings were summarized. Treatment courses were identified as well as patients' outcome., Results: We report the case of a 41-year-old man, so far in good health, presenting with massive hemoptysis. Bronchoscopy showed blood clots and a protruding lesion covered by mucosa with a white pointed cap at the entrance of the right upper lobe. Biopsies were not attempted. Embolization of bronchial artery was first realized and was not successful, with post procedure complications. Surgical intervention stopped the bleeding and pathological examination of the resected specimen confirmed Dieulafoy's disease of the bronchus. Ninety cases of BDD were reported from 1995 to 2022. The main symptom was hemoptysis. Chest imaging findings were not specific. The diagnosis of BDD was mainly based on the bronchoscopy, branchial angiography and pathological findings or surgical specimens. Bronchoscopy findings were mostly nodular or prominent lesions (52.4%). Twenty-eight patients underwent bronchoscopic biopsies, 20 had massive bleeding and 10 died. Bronchial angiography mainly showed tortuous and dilation of bronchial artery, and the lesions were mainly located in the right bronchus. Selective bronchial artery embolization (SBAE) was performed in 32 patients and 39 patients underwent surgery., Conclusion: To our knowledge, this is the first case of bronchial Dieulafoy's disease to be reported in Tunisia and North Africa. When the diagnosis is suspected, bronchoscopic biopsy should be avoided as it might lead to fatal hemorrhage. Selective bronchial artery embolization can stop the bleeding, but surgery can be required., (© 2023. The Author(s).)

Background: Adverse childhood experiences (ACEs) are a prevalent health problem worldwide. Different side effects have been linked to this issue such as sleep disorders. This matter is well known. However, its influencing mechanisms are not well investigated in literature., Objective: To investigate the mediating role of internet addiction in the relation between adverse childhood experiences (ACEs) and sleep disorders among a population of high-school students in the region of Gafsa (Tunisia)., Participants and Setting: We performed a cross-sectional study, in February 2020, including adolescents registered in all secondary schools of Gafsa city., Methods: Sleep disorders were evaluated via the Pittsburgh Sleep Quality Index, internet addiction via the Internet Addiction Test and adverse childhood experiences via the Adverse Childhood Experiences-International Questionnaire., Results: A total of 414 students were enrolled in our study with a mean age of 17.18 ± 1.5 years. Exposure to intra-familial violence was more reported than social adversities with 99.1 % and 84 % respectively. Males showed higher rates of internet addiction (82.9 % vs 78.3 %, p < 0.001). Sleep disorders were reported in 94 % of students, predominantly among females (95.4 % vs 91 %, p < 0.001). Our results revealed that ACEs predict sleep disturbances through internet addiction (% mediation =18.3 %, p = 0.005). More particularly, an important mediation effect of internet addiction on the relationship between ACEs and sleep disorders was found among females (% mediation =30 %)., Conclusion: Internet addiction was found to be a mediating factor in the relation between ACEs and sleep disturbances among Gafsa high school students., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Introduction: Amyloidosis is a rare illness characterized by the deposition in organs of amyloid, which can be detected by histological staining. Amyloidosis restricted to the lower respiratory tract is unusual., Results: We reported the case of a 68-year-old woman with no history of chronic diseasewho presented with dyspnoea on exertion, cough and fatigue. The physical examination was unremarkable. A CT scan showed a cystic mass with a thickened wall in the apical segment of the left lower lobe. A biopsy of the mass was performed, and histological and immunohistochemical study confirmed the diagnosis of AL amyloidosis. The patient's clinical and radiological symptoms spontaneously improved without treatment after 3 years., Conclusion: Amyloid-related cystic lung disease is a rare presentation of amyloidosis in the thorax. More case reports are required to determine if such masses can resolve without treatment and whether amyloid-associated cystic lung disease actually exists., Learning Points: Dyspnoea and cough are a rare atypical presentation that can reveal pulmonary amyloidosis.A cystic lung mass should raise suspicion for pulmonary amyloidosis.Clinical symptoms and radiological findings of a cystic mass spontaneously resolved without treatment after 3 years in this patient with pulmonary amyloidosis., Competing Interests: Conflicts of Interests: The authors declare there are no competing interests., (© EFIM 2022.)

Right hepatic artery pseudoaneurysm following laparoscopic cholecystectomy is rare, but its rupture is common. It carries a high mortality rate if not successfully timely managed. In laparoscopic era, surgeons and physicians in general must be aware of this entity and its therapy. Conservative management is not recommended due to the propensity to rupture. Treatment consists on reconstructive surgery or ligation, but coil embolization is the treatment of choice nowadays and should be done without delay. KEY WORDS: Cholecystectomy, Embolization, Laparoscopy, Pseudoaneurysm rupture, Right hepatic artery.

Malaria continues to be a major health problem in many parts of the world especially in the endemic countries. Though, because of the international travelling, any physician everywhere should know this disease and its complications such as splenic rupture which is rare but life threatening. We report the case of an expatriate Tunisian man who had been working in Togo and who had consulted in Tunisia for an acute abdominal pain. Explorations concluded to a splenic rupture, a rare complication of malaria. Our attitude was conservative based on ressuscitation with monitoring and watchful waiting. The evolution was favorable marked by a significant regression of the splenic hematoma 5 months after hospital discharge. KEY WORDS: Haematoma, Malaria, Splenic rupture, Sub capsular.

Background: Massive haemoptysis is a rare symptom ofcoronavirus disease 2019 (COVID-19). Management can be very challenging due to the lack of clear recommendations., Case Description: We report a case of massive recurrent haemoptysis in a young patient who tested positive for COVID-19 with successful management using endovascular embolization., Discussion: Life-threatening massive haemoptysis has rarely been reported as the only manifestation of COVID-19. Embolisation was the therapeutic option chosen to manage this emergency., Learning Points: Haemoptysis is a rare atypical presentation that can reveal COVID-19, highlighting the complexity of its pathogenesis.Atypical manifestations should raise suspicion for COVID-19.In this patient with COVID-19, life-threatening massive haemoptysis was successfully treated with endovascular embolisation., Competing Interests: Conflicts of Interests: The authors declare there are no competing interests., (© EFIM 2022.)

Introduction: Self-medication of antibiotics among children is a very common problem in Tunisia. Its prevalence isn't well established. The aims of this study are to evaluate parents' knowledge concerning antibiotic use, and identify the factors associated with this problem., Patients and Methods: We conducted a cross-sectional study over a one year period (between August 2019 and July 2020). Data collection was performed using a questionnaire guided interview. We included parents of children consulting or hospitalized in the pediatric department of the university hospital Taher Sfar in Mahdia., Results: A total of 354 parents were included with an average age of 36.4±9.2 years. The average knowledge score was 2±1.3 points. In fact, 61.6% of the parents had poor knowledge about antibiotics. The frequency of non-prescription antibiotics use among children was 20.6%. Amoxicillin was the most used antibiotic (72.6%). Sore throat, important fever and flu-like symptoms were the main symptoms justifying non-prescription antibiotic use among our pediatric population in 60.3%, 34.2% and 23.3% of cases respectively. The main reason of self-medication was the fact that the same antibiotic was once prescribed to treat the same symptoms (58.9%). The used antibiotic came from an old prescription for the same child in 57.5% of the cases and was recommended by the pharmacist in 39.7% of the cases. After multivariate analysis, the factors associated with parental self-medication with antibiotics were: the advanced parent's age, the ability to name an antibiotic and knowledge's score>2., Conclusion: Our study confirmed that parental knowledge about antibiotic use is low. In fact, the government should from one hand, organize antibiotic delivery and prohibit off the counter sells and in the other hand promote the education of the public through different procedures to stop this major health problem., (Copyright © 2021 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: The goal of our study was to create a cross-cultural adaptation of the questionnaire « National Eye Institute Visual Function Questionnaire » (NEI-VFQ-25) for the Tunisian population (Tu-VFQ-25) and to test its psychometric properties in a group of patients with chronic uveitis., Patients and Methods: The study consisted of two steps. The first was translation of the NEI-VFQ-25 and its cross-cultural adaptation to the Tunisian dialect (Tu-VFQ-25) according to the guidelines of Beaton et al. The second step consisted of studying the psychometric properties of the Tu-VFQ-25. Enrolled patients, diagnosed with chronic uveitis, were interviewed face-to-face by two different investigators, followed by a telephone interview by the first investigator 48hours later. Feasibility, internal consistency and reproducibility of the Tu-VFQ-25 were then tested using statistical methods., Results: The mean time taken to administrate the questionnaire to each of the 45 patients was 11min 40 s (± 2min 24 s). Internal consistency was acceptable, with Cronbach's alpha coefficients above 0.7 except the "Ocular Pain" and "Driving" subscales (0.645 and 0.559 respectively). Inter-observer reliability was excellent, with intra-class correlation coefficients (ICC) ranging from 0.857 to 0.985 for all subscales. Test-retest reliability, assessed for 43 patients, was good to excellent, with ICC above 0.80 for all subscales except "General Vision," which had a value of 0.786., Conclusion: As with previous versions, the Tu-VFQ-25 is an easy and reliable tool for assessing vision-related quality of life of Tunisian patients with chronic uveitis., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Objective: The aim of the study was to assess the effectiveness of a new methodological tool for the identification of corrective and preventive actions (CAPAs) after root cause analysis of health care-related adverse events., Methods: From January to June 2010, we conducted a randomized controlled trial involving risk managers from 111 health care facilities of the Aquitaine Regional Center for Quality and Safety in Health Care (France). Fifty-six risk managers, randomly assigned to two groups (intervention and control), identified CAPAs in response to two sequentially presented adverse event scenarios. For the baseline measure, both groups used their usual adverse event management tools to identify CAPAs in each scenario. For the experimental measure, the control group continued using their usual tools, whereas the intervention group used a new tool involving a systemic approach for CAPA identification. The main outcome measure was the number of CAPAs the participants identified that matched a criterion standard established by eight experts., Results: Baseline mean number of identified CAPAs did not differ between the two groups (P = 0.83). For the experimental measure, significantly more CAPAs (P = 0.001) were identified by the intervention group (mean [SD] = 4.6 [1.7]) than by the control group (mean [SD] = 2.8 [1.2])., Conclusions: For the two scenarios tested, more relevant CAPAs were identified with the new tool than with usual tools. Further research is needed to assess the effectiveness of the new tool for other types of adverse events and its impact on patient safety., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.)

Adverse childhood experience (ACE) has become an alarming phenomenon exposing youth at a great risk of developing mental health issues. Several studies have examined the mechanism by which ACE affects adolescent's engagement in risky behaviors. However, little is known about these associations in the Tunisian/African context. We investigated the role of impulsivity in the link between ACE and health risk behaviors among schooled adolescents in Tunisia. We performed a cross sectional study among 1940 schooled adolescents in the city of Mahdia (Tunisia) from January to February 2020. To measure ACE, we used the validated Arabic version of the World Health Organization ACE questionnaire. The Barratt Impulsivity Scale and the Internet Addiction Test were used as screening tools for impulsivity and internet addiction. A total of 2520 adolescents were recruited. Of those, 1940 returned the questionnaires with an overall response rate of 77%. The majority (97.5%) reported experiencing at least one ACE. Emotional neglect (83.2%) and witnessing community violence (73.5%) were the most reported intra-familial ACEs. Males had higher rates of exposure to social violence than females. The most common risky behavior was internet addiction (50%, 95%CI = [47.9-52.3%]). Our survey revealed that ACEs score predict problematic behaviors through impulsiveness (% mediated = 16.7%). Specifically, we found a major mediating role of impulsivity between the exposure to ACE and the risk of internet addiction (% mediated = 37.5%). Our results indicate the role of impulsivity in translating the risk associated with ACE leading to engagement in high risk behaviors., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 Published by Elsevier Inc.)

Objective: To assess the distribution of cardiovascular risk factors in Maghreb's countries., Methods: It is a systematic review including articles and reports that applied the WHO "STEPwise" approach, or a similar approach, studying cardiovascular risk factors in the Maghreb countries: Tunisia, Morocco, Algeria, Libya and Mauritania between 2004 and 2018., Results: We selected five articles, a report for each country. The prevalence of smoking was between 13.4% (12.2-14.6) in Morocco and 29.4% (28.3-30.4%) in Tunisia. 50.6% of the population of Mauritania had insufficient physical activity. The prevalence of high blood pressure was highest in Libya (40.6%) The prevalence of obesity was up to 41.1% (37-43.3) for women and 21.4% (19-23.8) in men in Libya. The prevalence of diabetes mellitus was between 10.6% (9.7-11.6) in Morocco and 16.4% (14.7-19.1) in Libya., Conclusion: The distribution of cardiovascular risk factors in the Maghreb countries shows that the level of cardiovascular risk is high, particularly in the central Maghreb. This attests to the fairly advanced epidemiological transition related to the rapid modernization of the Arab countries, hence the importance of launching an integrated project for the fight against cardiovascular diseases based on the global experience.

Objective: The aim of the study was to prospectively assess the incidence, the preventability, and the factors contributing to adverse events (AEs) in surgical departments of Tunisian hospitals., Methods: A prospective longitudinal study evaluated the incidence of AEs in surgical departments of three university hospitals in central Tunisia. The study followed 1687 admitted patients until their discharge from the hospitals based on a standard two-stage method that first included staff interviews and review of medical records based on 18 criteria and later was followed by an expert review to confirm or reject the presence of an AE., Results: The overall incidence of AEs was 18.1% (95% confidence interval = 16.26-19.94), with an incidence density of 21.6 events per 1000 patient-days. The most frequent AEs were those related to operative procedures (34.9%) and to hospital-acquired infections (30.3%).The multivariate analysis shows that the proportion of AEs increased significantly with intrinsic risk factors (odds ratio [OR] = 2.51, P < 0.001), extrinsic risk factors (OR = 1.38, P = 0.02), length of stay of greater than 7 days (OR = 2.27, P < 0.001), and unplanned admissions (OR = 2.59, P < 0.01). Overall, the major consequences of suffering an AE were that 90% had a prolonged hospital stay, 6% had a permanent disability, and 4% encountered death. More than 60% of the identified AEs were considered to be preventable., Conclusions: Surgical AEs have a significant impact on patient outcomes in terms of length of stay, disability, and mortality, and a considerable proportion of them are preventable. Prospective studies provide better insight regarding AEs under circumstances where hospital records are not optimal. Patient safety programs led by qualified health professionals can reduce patient harm in surgical departments of hospitals in most situations.

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., (© Society of Behavioral Medicine 2018. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: To determine the prevalence, risk factors as well as consequences of exposure to violence among youth in Maghreb countries., Methods: This is a systematic review. The documentary request was done on 2 October 2019 and no filters were used. It examined all scientific publications indexed in Medline database via Pubmed using the following search equation: ("Violence"[Mesh] OR "suicide"[Mesh] OR "crime victims"[Mesh] OR "Child abuse"[Mesh]) AND ("Young Adult"[Mesh] OR "Adolescent"[Mesh] OR "Child"[Mesh]) AND ("Tunisia"[Mesh] OR "Algeria"[Mesh] OR "Morocco"[Mesh] OR "Libya"[Mesh] OR "Mauritania"[Mesh])., Results: A total of 16 articles were included. Most of them (68.7%) were published in Uganda, United States and England. The most common type of violence was physical abuse (43.8%). Adolescent boys were mostly affected by physical violence. However, girls were more exposed to emotional violence (63% vs 51%). The suicide rate increased after the social and political Tunisian revolution in 2011. Parental conflicts, school failure and social problems were more frequent among victims of violence. In addition, tobacco and alcohol use, substance abuse and suicide attempt (ranging from 5% to 38%) were higher., Conclusion: Exposure to violence, especially emotional and physical, is becoming more frequent among youth in Maghreb countries. There is an urgent need for future survey to provide temporal data about violence, especially sexual abuse, in order to implement more effective prevention strategies.

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., (Copyright © World Health Organization (WHO) 2019. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Objective: To describe both editorial and thematic profile of biomedical publications related to the theme «Ramadan and Health», indexed in «Medline» database till December 31th 2018., Methods: This is a bibliometric study via «Medline» database using the following documentation query: «Fasting» [Majr] AND («Islam» [Majr] OR Ramadan [All Fields]). Data was collected through the «Medline» Material Safety Data Sheets from the NLM Library. Publications' themes have been defined by major descriptors (Majr). The generic descriptor corresponded to the Majr word hierarchically superior in the «Medline» Mesh descriptor thesaurus., Results: A total of 508 articles were captured, of which 13% were reviews and 5% were randomized controlled trials. These publications were published by 272 journals belonging to 38 countries, and signed by 108 authors in first position and 398 in last position. The number of major descriptors used to index these publications related to «Ramadan and Health» was 484. Endocrine System Diseases (Diabetes mellitus) and Human Activities (Exercise) were the main major generic keywords, indexing respectively 28% and 20% of this literature., Conclusion: «Ramadan and Health» is increasingly, a theme of scientific and biomedical research of great interest worldwide in order to manage health problems, especially diabetes mellitus. Expanding the scope of its applications to other global burden of disease's areas would be useful.

Aim: To quantify the physical workload during the Ramadan 2015 (summer season) and to verify if this load changes significantly compared with periods of non-fasting (in summer or winter seasons)., Methods: It was an18-month prospective cohort study conducted in a brickyard and a textile manufacturing company located in the governorate of Monastir (Tunisia). It was based on the results of three visits: The first one (V1) was carried out in the month of Ramadan in the hot season, the second visit (V2) took place in the hot season outside of Ramadan and the third one (V3) was in the cold season outside of Ramadan. During these visits twelve male workers from each company matched by age filled out a questionnaire and went through a heart rate recording according to the recommendations of the analysis level of the International Organization for Standardization 8996 enabling the evaluation of the physical workload., Results: During Ramadan, the physical workload was rated as «Medium» without any significant difference between the equivalent metabolic rate means ± SD of the two groups (287.00±70.5 and 224.21±43.01W respectively in the brickyard and in the textile manufacturing company). The working metabolic rate and the percentage of use of the maximum working capacity decreased in V2 and in V3 with no significant difference between the two companies and the three measurement visits., Conclusion: The physical workload in the month of Ramadan measured in two different activity sectors was found to be «Medium» and did not significantly differ from that noted in the non-fasting periods (outside of Ramadan).