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Introduction:les procédures de cardiologie interventionnelle sont devenues complexes et chronophages avec un sur-risque d´exposition aux rayonnements ionisants. L´objectif de notre étude était d´évaluer le niveau des connaissances et des pratiques en radioprotection des cardiologues Tunisiens exposés au rayon X. Méthodes:notre étude est descriptive analytique réalisée en octobre 2019, organisée sous forme de questionnaire anonyme des connaissances et pratiques en radioprotection et envoyé à tous les Cardiologues Tunisiens exposés aux rayons X. Résultats:parmi 126 cardiologues exposés aux rayons X et ayant reçu le questionnaire, 58 médecins ont répondu au questionnaire (48%), avec une prédominance masculine (72%, n=42). Trente-huit médecins (65%) exerçaient dans le secteur public. L´expérience professionnelle était en moyenne de 12,02 ans (ET 6,88 ans). La moitié des médecins avaient un score de connaissances inférieur à 50%. La moyenne du score des pratiques était de 43,83 (ET 13,95%). Le port du tablier en plomb, de la cache thyroïde, du dosimètre, des lunettes en plomb, du calot en plomb était respectivement de 100% (n=58), 86,2% (n=50), 30,7% (n=18), 12,1% (n=7) et 1,7% (n=1). Il n´y avait pas de corrélation entre les scores et l´âge du médecin ainsi que la durée de l´expérience professionnelle. Les scores de connaissances ne différaient pas statistiquement entre les 2 sexes (p=0,06) ni entre le secteur public et le secteur privé (p=0,9). Le score de pratique était significativement plus élevé chez les hommes (0.007) et les cardiologues interventionnels comparés aux rythmologues et cardiopédiatres (p

Reprocessing of reusable medical devices (RMD) play an important role in the prevention of health-care associated infections. In this perspective, this study aimed to evaluate the impact of a training program intervention on health-care workers' (HCWs) knowledge and hospital practices about the reprocessing of RMD as a main strategic axis of infection control.We led a pre-post quasi-experimental study to evaluate knowledge of HCWs and to assess hospital practices in reprocessing RMD before and after a training intervention from May to November 2020 in Hedi Chaker University Hospital. A self-administrated questionnaire was distributed for each participant to assess knowledge. To evaluate practical skills, an audit grid was used.Overall, 30 participants were included. All HCWs had a fair level of knowledge before training. The knowledge score (KS) has significantly risen from pre to post-training (64/100 vs. 80/100; P0.001). When stratified by RMD type, a significant increase was noted on post intervention in KS about thermo-sensitive RMD reprocessing (P=0.044) and sterilization of thermo-resistant RMD (P=0.004). As for practice assessment, 5 (62.5%) departments had a fair level of practice. The conformity score (CS) did not significantly change from baseline to post-follow-up (53.5 vs. 56.2; P=0.06). According to the audit sections, we did not find a significant change in the pre- and post-intervention CS in sterilization process (70 vs. 80; P=0.06) and in the cleaning and decontamination steps (66.7 vs. 67; P=0.18).As opposed to practical skills, positive impact of the training intervention on HCWs knowledge was noted, which underlined the gap between theory and practice.

first-line physicians should play a key role in tobacco control. The purpose of this study is to assess the knowledge and attitudes of front-line physicians as well as their practices for smoking cessation, assess their smoking status and determine the barriers to smoking cessation support.we conducted a cross-sectional study among a representative sample of front-line physicians practising in the governorate of Sfax in November 2020.a total of 115 first-line physicians were included in the study, with a sex ratio (M/F) of 0.91 and an average age of 43 years (interquartile interval= [34-55 years]). Among the respondents, 26 (22.6%) stated that they were smokers; 98 of the physicians surveyed (85.2%) had not had any postgraduate training in smoking cessation. However, 71 (61.7%) had an idea on nicotine replacement therapy. Regarding attitudes,73 respondents (63.5%) were convinced that physicians were responsible for helping their patients quit smoking. Forty five physicians (39.1%) systematically asked all patients about their smoking habits. The least performed activities of the 5A strategy were the components "help" (14%) and "organize follow-up" (17.4%). Patients' disinterest was considered (53%) to be a significant barrier to smoking cessation assistance by the 61 physicians surveyed.there is a need to evaluate and improve the implementation of the national tobacco control strategy, in particular with regard to the training of front-line physicians.

Background Several studies have suggested that polymorphisms within genes encoding T‐lymphocyte immune regulating molecules: CD28, CTLA‐4, and ICOS, may alter the signaling process and subsequently could be involved in susceptibility to a broad spectrum of autoimmune diseases. Methods This study aimed to replicate associations between common polymorphisms in the 2q33.2 cluster and susceptibility to pemphigus foliaceus (PF) in the Tunisian population. We investigated seven polymorphisms: rs3116496 and rs1879877 (CD28), rs231775, rs3087243, and (AT)n repeat (CTLA4); rs11889031 and rs10932029 (ICOS) in a case–control study which enrolled 106 Tunisian PF patients and 205 matched healthy controls. Results We confirmed the associations with CTLA4((AT)13, p = 0.00137, OR = 3.96 and (AT)20, p = 0.008, OR = 5.22; respectively) and ICOS genes (rs10932029>CT, p = 0.034, OR = 2.12 and rs10932029>TT, p = 0.04 and OR = 0.41). Conclusion Our results indicate that susceptibility to PF is located in the proximal and the distal 3′ flanking region of the CTLA4/ICOS promoter. These findings may open avenues to the treatment of patients with biological drugs targeting CTLA4/ICOS molecules, in a personalized manner to achieve more effective treatment., Polymorphisms of 2q33 genes have not been analyzed in Tunisian endemic PF disease to date. Our study confirmed a strong association of CTLA‐4 (AT) repeat and ICOS>+173TC of 2q33.2 with the risk of PF in the Tunisian population.

Pemphigus foliaceus (PF) is considered to be caused by the combined effects of susceptibility genes and environmental triggers. The polymorphisms of Toll-like receptors (TLRs) genes have been associated with the risk of various autoimmune diseases. The aim of this study was to evaluate the potential association of TLR2-3-4 and 7 gene polymorphisms with Tunisian PF. Fourteen polymorphisms were analyzed in 93 Tunisian PF patients compared to 193 matched healthy controls: rs5743703-rs5743709 and (GT)n repeat (TLR2); rs5743305, rs3775294, and rs3775291 (TLR3), rs4986790 and rs4986791 (TLR4); and rs3853839 (TLR7). Our results showed that the genetic factors varied depending on the epidemiological feature stratification. In fact, in the whole population, no association with the susceptibility to PF was found. The TLR2 GT repeat seems to be closely associated with PF risk in patients originated from the endemic localities (group 3); the GT18 allele and the heterozygous genotype GT18/GT19 seem to confer risk to endemic PF ( P = 0.02 ; OR = 2.3 [1.1-4.9] and P = 0.0002 , OR = 20 [2.5-171], respectively). In contrast, the GT23 repeat could be considered as protector allele ( P = 0.02 , OR = 0.2 [0.06-0.87]). Furthermore, medium GT alleles which induce high promoter activity were also significantly more frequent in patients versus short or long GT repeats ( P = 0.0018 with OR = 3.26 [1.5-7]). On the other hand, the TLR3-rs574305 AA genotype and A allele were significantly more frequent in patients whose age of the onset was above 35 years (group 2) ( P = 0.038 , OR = 1.78 and P = 0.009 , OR = 3.92 , respectively). Besides, the TLR4>rs3775294 A allele was found to be protector only in patients with sporadic features (groups 2 and 4) ( P = 0.03 , OR = 0.57 [0.3-0.9] and P = 0.006 , OR = 0.24 [0.08-0.74], respectively). No statistically significant difference was observed in the genotypic and allelic frequencies of TLR-4 and TLR-7 gene polymorphisms. The present data suggest that TLR2and TLR3 polymorphisms are significantly associated with increased susceptibility to PF in the Tunisian population.

Worldwide, many more males than females were diagnosed with tuberculosis (TB) and died from it globally. In light of this, examining the gender differences among patients with TB is crucial to institute effective prevention, coverage and treatment.To analyze gender differences in the epidemiological, clinical and evolutionary specificities of TB in Southern Tunisia.We conducted a retrospective study including all new cases of TB of any age, diagnosed between January 1995 and December 2016. Data were collected from the regional register of TB at the Center of Tuberculosis Control of Sfax, Southern Tunisia.We recorded 2771 new cases of TB. The sex ratio was 1.2. We noted 1160 new cases with pulmonary TB (PTB) (41.9%). Males were more likely to have PTB than females (Odds Ratio (OR)=2.5;p0.001), while extra-pulmonary TB (EPTB) was more common in females (OR=0.4;p0.001). Lymph node (OR=2.6;p0.001), cutaneous (OR=2.3;p0.001) and abdominal TB (OR=2;p0.001) were significantly more frequent in females. Pleural TB was significantly more common in males (OR=1.2; p0.001). Case fatality rate was significantly higher in males (OR=1.7;p=0.02). Females experienced recovery more frequently (OR=1.3;p=0.04). Treatment duration was significantly higher in females (8.88±3.6months vs.8.41±3.2months; p0.001). Between 1995 and 2016, the age standardized notification rate (ASNR) of TB (Rho=0.68; p0.001) and EPTB (Rho=0.59 p=0.003) had significantly increased in females, while it had not significantly changed in males.Our study highlighted higher burden and morbidity in males in TB cases in Southern Tunisia. National TB programs should actively focus on these facts with more routine diagnostic and screening targeting males.

The presence of cardiocirculatory dysfunction in liver cirrhosis has been described since 1960 and it was exclusively attributed to alcoholic cardiomyopathie. Only in the last two decades, the term of cirrhotic cardiomyopathy (CCM) was introduced to describe cardiac dysfunction in patients with cirrhosis. This entity is currently underdiagnosed because the disease is usually latent and manifests when the patient is under stress. However, overt cardiac failure has been described after transjugular intrahepatic portosystemic shun and liver transplantation. The diagnosis of CCM is still difficult to determine because of the lack of specific diagnosis tools. CCM is characterized by systolic dysfunction, diastolic dysfunction and electrophysiological abnormalities. At present, there is no specific treatment outside liver transplantation in the light of increased mortality and postoperative complications.Our review provides an overview of CCM, its definition, prevalence, pathogenic mechanisms, clinical presentation, various explorations and management in light of the most recent published literature.

Introduction La realisation d’un audit en hygiene hospitaliere s’inscrit dans une dynamique globale d’amelioration de la qualite et de la securite des soins et constitue une bonne alternative aux approches classiques d’inspection sanitaire. L’objectif de ce travail etait de presenter les resultats d’un audit global d’hygiene hospitaliere et d’en faire ressortir les recommandations pour les prochains passages. Materiels et methodes Il s’agissait d’un audit d’observation effectue durant les mois de novembre et decembre 2019 dans tous les services d’un hopital universitaire. La grille proposee comporte 100 criteres regroupes en dix domaines. Trois modalites peuvent etre envisagees pour chaque critere : conforme, non conforme, non approprie. Un taux partiel de conformite etait attribue a chaque domaine a l’issue de chaque audit = [(nombre de criteres conformes/nombre de criteres observes) × 100]. Un taux global de conformite = [(nombre total de criteres conformes/nombre total de criteres observes) × 100] etait calcule a l’issue de chaque passage. Resultats Globalement, le taux de conformite aux bonnes pratiques d’hygienes etait de 40,2 %. Le meilleur taux de conformite (69,4 %) etait note dans le domaine de promotion de l’hygiene, suivi par celui de la lutte contre les nuisibles (54,8 %). Le taux le plus bas etait note pour le domaine de la literie, materiel et equipement (24,7 %). Le taux de conformite etait ≥ a 50 % dans 20 % des domaines (2 domaines parmi 10). Le meilleur taux global de conformite etait enregistre dans l’unite de greffe de nephrologie (63,7 %). Un service de psychiatrie a affiche le taux le plus bas a 17,4 %. Dans ce service, aucun critere de conformite n’a ete rempli dans les domaines de la literie, materiel et equipement, circuit linge, hygiene des mains et hygiene du personnel et des malades. Nous avons note que 4 services avaient un taux global de conformite ≥ a 50 %, soit 16,7 % des services. Conclusion Cet audit a revele des defaillances majeures dans plusieurs domaines d’hygiene evalues. Ces ecarts pourraient etre imputables a des problemes materiels, comportementaux, organisationnels et culturels. Ainsi, chacun doit contribuer a faire comprendre et respecter les bonnes pratiques d’hygiene pour ameliorer la qualite des soins.

Background Perianal manifestations of Crohn’s disease considerably affects the life quality of patients. This study aims to assess the quality of life of patients with perineal Crohn’s disease by using the SIBDQ (Short Inflammatory Bowel Disease Questionnaire) and to evaluate its correlation with the Perineal Disease Activity Index (PDAI). Methods We retrospectively reviewed the medical records of patients with perineal Crohn’s disease between January 2018 and December 2020. Patients with active luminal disease were not included in this study (Crohn’s Disease Activity Index (CDAI) > 150). All participants answered the SIBDQ. Active perineal disease was defined as a PDAI > 7. We studied the correlation between SIBDQ and PDAI. Patients were divided into 2 groups according to the duration of the disease greater or less than 5 years. SIBDQ and PDAI were compared between the 2 groups. Results We included 52 patients with a mean age of 37 years (range: 17–62 years). There were 34 males (65.4%) and 18 females (34.6%). Crohn’s disease has been diagnosed for 7.6 years in average (range 2–19 years). The PDAI varied from 1 to 15 (average=7) and the SIBDQ ranged from 11 to 66 (average= 41). The SIBDQ was inversely correlated to the PDAI with a Pearson’s correlation coefficient equal to -0.885 (p=0.01). Indeed, the SIBDQ score for patients with an active perineal disease was significantly lower than those with inactive one (28.3 ± 11.6 vs. 50.1 ± 7.7; p< 0.0001), which indicates a worse life quality. Comparing the 2 groups, there were no significant differences in terms of age, gender and PDAI. The SIBDQ was lower in patients who had the disease for more than 5 years compared to the other ones (38.3 ±15.6 vs.48.2 ± 7.5; p=0.003). Conclusion The quality of life for patients with perineal Crohn’s disease seems to be altered by both activeness and duration of the disease. The SIBDQ is a simple tool that helps physicians detect patients with poor life quality. Other studies are necessary to validate this questionnaire for the evaluation of the quality of life in patients with perineal Crohn’s disease.

Background Anemia is the most common extra intestinal complication in Inflamatory Bowel Diseases (IBD) affecting the quality of life of patients. Iron deficiency and inflammation are the two most common mechanisms. It has been suggested that controlling disease activity is sufficient to correct well-tolerated anemia. Anti-TNF α by their powerful anti-inflammatory action and their role in increasing the growth of erythroid progenitors can lead to correction of anemia. The aim of this work was to determine the effect of anti-TNFα on the course of anemia in Crohn’s disease (CD). Methods This is a single-center retrospective study including patients followed for CD, between 2011 and 2017, on anti-TNF. Anemia was tested in these patients before the initiation of anti-TNF. After six months of treatment, a correlation between the achievement of therapeutic efficacy and the correction of the anemia was sought. The judgment criteria adopted were: clinical response (CDAI score Results 120 patients were included, 60% of whom are female. The mean age at diagnosis was 29.8 years [12–56 years]. The mean duration of the disease was 7.42 ± 4.8 years. The disease phenotype was penetrating in 55% of cases and structuring in 45% of patients. Anoperineal manifestations (PAD) were noted in 20% of patients. 50% of patients were on Adalimumab, 50% on Infliximab and 45% of cases were on combination therapy. The indications for Biotherapy were: the presence of anoperineal manifestations (20%), failure of immunosuppressants (25%), postoperative recurrence (20%), intolerance to immunosuppressants (20%), and extradigestive manifestations in particular articular (15%). Pre-therapy, anemia was noted in 84 patients (70%), most of whom had chronic microcytic hypochromic anemia. The presence of anemia was well correlated with disease activity (p = 0.038). During the control, correction of anemia was obtained in 72 patients (60%), with a statistically significant association with the therapeutic efficacy criteria (clinical response: p Conclusion Our study showed the effectiveness of anti-TNF alpha agents in correcting anemia in Crohn’s disease. Larger scale studies are needed to confirm our results.

Background Fatigue is one of the most common symptoms reported by patients with chronic inflammatory bowel disease (IBD), being in flare or in remission. Thus, several fatigue measurement tools have been developed. The objective of our work was to assess the prevalence of fatigue in patients with IBD and its impact on daily life, and to determine its risk factors. Methods This is a cross-sectional study of patients followed for IBD who presented to our consultation during the three months preceding the study. Fatigue assessment was performed by IBD-F score (The Inflammatory Bowel Disease Fatigue Self-assessment Scale). The higher the score, the more disabling the fatigue. The activity of Crohn’s disease (CD) was assessed by the Harvey-Bradshaw index (HBI), that of ulcerative colitis (UC) by the clinical Mayo score. Results One hundred patients were included. Thirty-two patients (32%) had UC and 68 patients (68%) had CD. The mean age was 42.18 years [16–81 years], with a predominance of men (sex ratio = 1.5). Severe disease activity was noted in 14 patients (20.6%) with CD and 10 patients (31.3%) with UC. Extra-intestinal manifestations, particularly articular, were noted in 20% of cases. 36% of patients were in clinical remission. The prevalence of fatigue was 94.11% in MC and 93.75% in RCH. Fatigue was noted in 83.3% of patients in remission.Fatigue was severe (section I score between 11 and 20) in 40% of patients. We found a significant association and a linear correlation between the presence and severity of fatigue and CD activity (p Conclusion Assessing the severity of fatigue and its impact on the daily activities of patients is a crucial pillar in the management of patients with IBD. In our series, the prevalence of fatigue was 94%. It was associated and correlated with the degree of disease activity.