Search

Background Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) mainly affects the respiratory tract, but different organs may be involved including the kidney. Data on acute kidney injury (AKI) in critical forms of coronavirus disease 2019 (COVID-19) are scarce. We aimed to assess the incidence, risk factors and prognostic impact of AKI complicating critical forms of COVID-19. Methods A retrospective descriptive case/control monocentric study conducted in a medical intensive care unit of a tertiary teaching hospital over a period of 18 months. Results We enrolled 144 patients, with a mean age of 58±13 years old and a male predominance (sex-ratio: 1.25). Forty-one (28%) developed AKI within a median of 4 days (Q1: 3, Q3: 8.5) after hospitalization. It was staged KDIGO class 3, in about half of the cases. Thirteen patients underwent renal replacement therapy and renal function improved in seven cases. Diabetes (OR: 6.07; 95% CI: (1,30-28,4); p: 0.022), nephrotoxic antibiotics (OR: 21; 95% CI: (3,2-146); p: 0.002), and shock (OR: 12.21; 95% CI: (2.87-51.85); p: 0.031,) were the three independent risk factors of AKI onset. Mortality was significantly higher in AKI group (OR: 3.94; 95% CI: (1.65-9.43); p−3) but AKI didn’t appear to be an independent risk factor of poor outcome. In fact, age (p: 0.004), shock (p: 0.045) and MV (p−3) were the three prognostic factors in multivariate analysis. Conclusions The incidence of AKI was high in this study and associated to an increased mortality. Diabetes, use of nephrotoxic antibiotics and shock contributed significantly to its occurrence. This underlines the importance of rationalizing antibiotic prescription and providing adequate management of patients with hemodynamic instability in order to prevent consequent AKI.

Background: The placenta accreta spectrum is a complex disorder characterized by abnormal invasion of the placenta into the uterine wall, posing a significant risk of life-threatening haemorrhage for patients. Its incidence is on the rise, largely attributed to the increasing rates of caesarean sections. Management of this spectrum involves a multidisciplinary approach, although standardized protocols are not yet established. While caesarean hysterectomy remains the standard Gold, several adjunctive treatments have emerged in recent years to mitigate bleeding risk and associated morbidity. Among these, prophylactic occlusion balloons placed in the internal iliac arteries have shown promise. The aim of our study is to demonstrate the effect of prophylactic occlusion balloons in both uterine iliac arteries in the management of placental accreta spectrum disorders. Methods: A retrospective monocentric cohort study was conducted in the Department ''C'' of Gynaecology and Obstetrics at the Maternity Center of Tunis. The study spanned three years, from January 2nd, 2020, to December 31st, 2022. The study population consisted of two groups: Control Group (CG) comprised patients who underwent caesarean hysterectomy without internal-iliac prophylactic occlusion balloons, and Occlusion balloons of both internal iliac arteries Group (OBIIAG) included patients who underwent caesarean hysterectomy with internal-iliac prophylactic occlusion balloons. Results: A total of 38 patients were included in the study, all of whom exhibited similar epidemiological characteristics and comparable personal and obstetric histories. The most prevalent risk factor among the patients was a history of caesarean section (92%). On average, patients were diagnosed at 30 weeks of gestation, with third-trimester bleeding being the most common presentation (71% of cases). The median gestational age at delivery was between 36 and 37 weeks. We observed a significant difference in blood loss between the two groups (2888 ml in the control group and 1828 ml in the group with internal-iliac prophylactic occlusion balloons, p

The US orange industry has been grappling with declining production since the early 2000s due to the outbreak of the Huanglongbing disease and various other challenges. To meet the market demand, the United States increasingly relies on imports, notably those from Mexico and Chile. This publication further explores the factors contributing to this trend and discusses potential solutions.

Pulse crops have become more important in food production and consumption systems for the transition towards sustainability. We present an agroecological dataset from 304 samples from 12 legume field trials in five locations across three countries in the Mediterranean. The field trials were established in the seasons 2021/22 and 2022/23 and tested different lentil or chickpea cultivars, inoculants, intercropping and weeding regimes. The dataset encompasses detailed information on wild flora diversity, grain yield, associated management practices, soil texture and weather during the growing period. Wild flora diversity was recorded by conducting a vegetation survey in 1 × 2 m sample plots. Grain yield was determined at the crop maturity stage, with full plots harvested in Spain, while samples were taken in Croatia and Tunisia. Environmental variables were via laboratory analysis or bottle testing of soil samples and analysis of local weather data. The comprehensiveness of the dataset, including all relevant agroecological information, enables other researchers to employ the dataset for various statistical analyses of agroecosystem processes, such as plant-environment interactions or biodiversity-yield trade-off analysis.

This report presents a rare case of bronchogenic adenocarcinoma with initial metastasis in the external auditory canal. The patient, a 64-year-old man with a history of bladder urothelial carcinoma, initially presented with a persistent right otitis externa. Otoscopic examination revealed a mass obstructing the right external auditory canal. The temporal bone computed tomography scan revealed a mass that completely obstructed the right external auditory canal and extended into the middle ear. A biopsy showed a poorly differentiated adenocarcinoma of bronchogenic origin, confirmed by positive immunohistochemical staining for cytokeratin 7 and Thyroid transcription factor-1. Further imaging revealed a large tumor mass in the lung involving the mediastinum and parenchyma, along with carcinomatous lymphangitis and cerebral metastasis. Histopathological examination of the primary lung tumor confirmed a poorly differentiated adenocarcinoma with similar features to the metastasis in the external auditory canal. The tumor was staged as T4N2M1c, and the patient underwent local external-beam radiation therapy with chemotherapy.

Background/objectives: Sewing machine operators (SMO) are the most likely workers to experience a high prevalence of musculoskeletal disorders in the textile, clothing, and footwear industries. We conducted a cross-sectional and exhaustive study among SMO working in the leather and footwear industry to describe the prevalence of multi-site musculoskeletal symptoms (MMS) and evaluate factors associated with their occurrence. Methods: Musculoskeletal symptoms declared by these operators were assessed through the modified Nordic questionnaire. The psychosocial work environment was assessed using the Karasek model. The variables associated with MMS were issued from binary logistic regression and decision tree using R software. Results: Of 145 operators, 65.5 % of men and 72.4 % of women had MMS. Based on binary logistic regression, a history of musculoskeletal disorders (MSDs) increased the risk of developing MMS by 8 folds. The binary decision tree identified five main nodes: history of MSDs, professional seniority, often finding the pace of work restrictive and male gender. Conclusion: Identifying homogeneous profiles of MMS's occurrence will help the implementation of an effective and targeted preventive strategy.

Introduction There is a growing concern about the link between musculoskeletal disorders (MSD) and psychosocial risk (PSR) among electricians. Both MSD and PSR represent a threat to the electrician’s health, quality of life and productivity. Objectives This study aimed to assess the link between PSR and MSD among electricians. Methods The study was conducted in a group from an electricity society. Data were gathered between January-June 2022 using a self-administered questionnaire evaluating socio-professional characteristics, the Nordic musculoskeletal questionnaire during the previous year and the validated French version of the questionnaire KARASEK. Results Our study included 68 male electricians. The mean age was 39.2 ± 10.3 years. The average job tenure was 16± 11.4 years. According to the Nordic musculoskeletal questionnaire, 50% of participants experienced pain during the last 12 months. About half of the electricians had high psychological demand (48.5%), 63.2% had a low latitude, and 76.5% had low social support. According to the Karasek model, tense electricians accounted for 26.5% and assets 22.1%. MSDs were associated with high psychological demand at work (p = 0.02). Conclusions This study demonstrated that PSR and MSDs are associated among electricians and are highly prevalent. They represent an important concern of the occupational and safety health system. The prevention of MSD should take into account the specific working conditions of electricians to reduce their exposure to psychosocial risk factors in the workplace. Disclosure of Interest None Declared

Introduction In the workplace, a smoke-free environment is crucial to guaranteeing the health of workers and those around them. Understanding the relationship between smoking and work is a prerequisite for implementing effective tobacco control measures. Objectives To assess the prevalence of smoking in an electricity and gas company in Sfax and to determine the relationship between workers’ nicotine dependence and perceived workload. Methods We conducted a cross-sectional survey evaluating the smoking behavior of 100 employees of an electricity and gas company. The survey was carried out from July to December 2022 using a two-part questionnaire. The first part was completed by the participants, and the second was administered by the interviewer. Nicotine dependence was assessed using the Fagerström test, while perceived workload was evaluated using the raw NASA-TLX questionnaire. Results Our study population consisted of 82 male participants. Active smoking was reported by 45.1% of participants. Among smokers, 40.5% had moderate to high nicotine dependence as assessed by the Fagerström test. According to the raw NASA-TLX questionnaire, the mean scores for mental, physical, and temporal demands were 88.8±13.5, 63.6±24.7, and 59.1±28.4, respectively. The mean scores for effort, performance, and frustration were 83.8±14, 85.4±13.1, and 34.5±28.1, respectively. Bivariate analysis indicated an inverse correlation between nicotine dependence and physical demands at work. However, a significant positive correlation was found between nicotine dependence and frustration at work. Conclusions Smoking among electricity and gas company workers is a prevalent issue, highlighting the urgent need for smoking cessation interventions. The association of smoking with perceived workload underscores the importance of preventive measures to reduce work-related stress. Disclosure of Interest None Declared

Introduction Smoking among university professionals could influence student smoking behavior, making it important to understand the associated factors to prevent this phenomenon. Objectives To determine the prevalence of smoking among University staff in Sfax, Tunisia, and identify its associated factors. Methods We conducted a cross-sectional survey using a self-administered questionnaire distributed to 100 university staff. The questionnaire included socio-professional characteristics, assessment of physical workload using the Borg CR-10 scale, and evaluation of nicotine dependence using the Fagerström test. Results Our study included 62 participants, with 67.7% of them being women. Active smoking was reported by 50% of male participants. We observed symptoms of severe to very severe depression, anxiety, and stress in 6.4%, 22.5%, and 9.7% of our participants, respectively. Nicotine dependence, as assessed by the Fagerström test, was high to very high in half of the smokers. Bivariate analysis indicated a significant association between smoking and male gender, perceived workload (33.9%), and body mass index. Conclusions Smoking among university staff is a prevalent phenomenon, especially among male participants. The association of smoking with perceived workload suggests the need for preventive measures to reduce these physical constraints. It is paramount to take actions to encourage smoking cessation among university staff. Disclosure of Interest None Declared

Introduction Job satisfaction is a fundamental pillar of the modern workplace. Recognizing the significance of job satisfaction and actively promoting it has become a strategic imperative in today’s work environment. Objectives The present study aimed to assess job satisfaction and work ability among workers in a confectionery factory. Methods A cross-sectional study conducted in a Sfax confectionery factory included 200 workers. Data were collected between December 2022 and July 2023 using a pre-established questionnaire. This questionnaire encompassed an evaluation of socio-demographic and professional data, measuring the degree of professional satisfaction and the level of work ability using a visual analogue scale ranging from 0 to 10. Results The gender ratio was 0.64. The mean age was 33.2 ± 8.8 years. Among our workers, 77.5% reported being satisfied with their work. The average perceived work ability score was 8.15 ± 2.087. Employees with higher levels of satisfaction were more likely to have increased work capacity (p = 0.000). Elevated job satisfaction not only boosts work capacity but can also reduce stress levels, improve overall mental well-being, and contribute to a healthier workplace environment. These factors collectively lead to higher work ability. Conclusions These findings emphasize the importance of prioritizing employee well-being to enhance overall productivity and company success. Fostering a work environment that prioritizes job satisfaction can lead to a more productive and successful workplace. Disclosure of Interest None Declared

Introduction In operating rooms, the routine use of radiological procedures is commonplace. However, this essential tool brings about significant concerns for healthcare workers due to the associated radiological risks. Understanding healthcare workers’ attitudes and perceptions about ionizing radiation is crucial for addressing these concerns. Objectives This study aims to assess the perceptions and concerns of healthcare workers regarding radiation risks and their practices in the operating room. Methods A cross-sectional study was conducted in February and March 2023 among the operating room staff of Habib Bourguiba University Hospital in Sfax, Tunisia. We used a self-administered questionnaire that included socio-professional data. Self-assessment of exposure risk and protection level against ionizing radiation was evaluated on a scale from 0 to 10, and attitudes were assessed using a 5-item Likert scale. Results Our study population consisted of 92 healthcare workers, with 54.3% being male. When asking operating room workers about the availability, accessibility, and quality of lead aprons, the median scores were 3 (IQR [0;6.5]), 2 (IQR [0;5]), and 2 (IQR [0;5]), respectively. The median self-assessment score for exposure risk was 8 (IQR [5.5; 10]), while the median self-assessment score for protection against ionizing radiation was 1 (IQR [0;3]). Sixty percent of the population had limited knowledge of the harmful effects of ionizing radiation, with a median self-assessment knowledge score of 1.5 (IQR [0;3]). Sixty-two percent reported concerns regarding radiological risks. In terms of practices, 44.5% of the staff maintained a distance from the radiation source during intraoperative radiography, and 21.7% used the apron for protection. Dosimeters were not used by any of the participants. Concerns level was associated with self-assessment of exposure risk (p = 0.027). Conclusions In conclusion, awareness of the risks generates anxiety and concern among staff; however, it alone is insufficient to alter our practices. This underscores the imperative for a proactive approach in implementing robust safety measures and comprehensive training programs. Disclosure of Interest None Declared

Introduction Mental health is a critical factor influencing employee well-being and performance in companies. However, many factors within professional environments can either positively or negatively impact employees’ psychological well-being. Objectives This study aims to assess mental health among workers in a confectionery factory and its association with job satisfaction. Methods We conducted a cross-sectional study among workers in a private confectionery in Sfax. Questionnaires and workplace assessments were collected over a period from December 2022 to July 2023 using a pre-established questionnaire. Mental health assessment was performed using the 21-item Depression, Anxiety, and Stress Questionnaire (DASS21). The degree of job satisfaction was assessed using a visual analog scale ranging from 0 to 10. Results Our study included 200 participants, with 61% being female. Severe to very severe symptoms of depression, anxiety, and stress were found in 4.5%, 17%, and 10.5% of our participants, respectively. Among our workers, 22.5% reported being not very satisfied or not satisfied. Bivariate analysis revealed lower levels of satisfaction among the most anxious (p = 0.000), the most depressed (p = 0.000), and the most stressed (p = 0.000) workers. Conclusions The decline in mental health is closely linked to job dissatisfaction. Implementing measures to enhance employee job satisfaction and providing adequate support resources for mental well-being are essential steps to promote a healthier workplace and improve employee well-being. Disclosure of Interest None Declared

Introduction Among young medical practitioners, the exigencies of daily practice entail many challenges concerning both physical and mental dimensions. The study of the interplay between these two dimensions is crucial to provide the necessary care for this population. Objectives This study aims to evaluate the prevalence of back pain and its association with mental health issues in young medical practitioners. Methods A cross-sectional study (January to April 2023) was conducted in the university interns and residents from Sfax. The Nordic questionnaire was used to evaluate back pain. The Generalized-Anxiety-Disorder (GAD -7) and the Patient-Health-Questionnaire (PHQ-9) were used to assess signs of anxiety and depression respectively. Results Our population consisted of 404 young doctors. One-hundred and twenty were males with a sex-ratio of 0.42. Among them, 76 (18.8%) had surgical specialties. Mean age was 28.03±2.89, BMI’s mean was 23.65±3.98. Medical history was reported by 29.2% and psychiatric history by 4.9%. The median of the PHQ-9 and GAD-7 score were 3.5 (IQ: [1;6]) and 2 (IQ: [0; 5]). Signs of depression were found in 11.1% of the population whereas anxiety was found in 8.4% of them. Sixty-seven residents (16.6%) reported having back pain in the previous year. Neck pain, upper-back pain and lower back pain were experienced by 8.7%, 6.4% and 10.1% respectively. Bivariate analysis showed that back pain was associated with PHQ-9 score (p=0.006), GAD-7 score (p=0.018) and it was not associated with BMI (p=0.769) neither with surgical specialties (p=0.824). Lower Back pain was associated with GAD-7 score (p=0.004). Conclusions Our study highlights the link between back pain and mental health problems in young doctors. Interventions englobing a better understanding of these two facets are needed to ensure an optimal care for this young population. Disclosure of Interest None Declared

Introduction Low back pain (LBP) is a serious threat to electricians. It is well known that LBP is associated with physical strain. But the impact of psychological workload on the occurrence of LBP needs further investigation. Objectives This study aimed to assess the link between LBP and perceived psychological workload among electricians. Methods The study was conducted with a sample of workers from a Tunisian Electricity society. Data were gathered between January-June 2022 using a self-administered questionnaire including socio-professional characteristics and the Nordic musculoskeletal questionnaire during the last 12 months and the last 7 days. To assess the perceived workload, we used the National Aeronautics and Space Administration Task Load Index (NASA-TLX). In this study, we evaluated raw NASA-TLX scores. Results Our study included 68 male electricians. The mean age was 39.2 ± 10.3 years. The average job tenure was 16± 11.4 years. According to the Nordic musculoskeletal questionnaire, 32.4% of participants reported low back pain during the last 12 months. Thirty participants (19.1%) had low back pain during the last 7 days. The mean score of mental demand, physical demand, performance, effort, frustration level and temporal demand were respectively 88.2±14.3, 61.1±24, 84.8±13.3, 82.6±14.5, 35.8±29.2 and 60.4±28.8. The frustration level was associated with the presence of LBP during the last 12 months and the last 7 days (p

Introduction Low back pain (LBP) is common among electricians caused by work conditions. Even when symptoms are short-term and not medically serious, LBP can be associated with psychological distress. Objectives This study aimed to assess the link between LBP and psychological distress according to the job tenure among electricians. Methods The study was conducted in a group from a Tunisian Electricity society. Data were gathered between January-June 2022 using a self-administered questionnaire including socio-professional characteristics, the Nordic musculoskeletal questionnaire during the last 12 months and Kessler Psychological Distress Scale (K6). Our population was divided into two groups according to job tenure. The first group (G1) consisted of electricians with less than ten years of job tenure and the second (G2) consisted of electricians with more than ten years of seniority. Results G1 consisted of 10 participants with a mean age of 30.6 ± 6.7 years and with average job tenure of 3.3 ± 1.1 years. G2 consisted of 64 participants with a mean age of 40.7 ± 10.3 years and average job tenure of 17.4 ± 10.9 years. According to the Nordic musculoskeletal questionnaire, LBP during the last 12 months was present in the first and the second group in 30.8% and 14.3% of participants, respectively. The proportion of respondents with high levels of psychological distress (K6 score of 13 or greater) in the first and the second groups was 10 % and 9.4% of participants, respectively. The presence of low back pain during the last 12 months was significantly associated with a high score of K6 in the second group (p < 0.05). Conclusions From the results of this study, we conclude that LBP was associated with psychological distress when the job tenure is high. Therefore, the prevention of LBP should go through programmes to build ergonomically safe working conditions to enhance the mental health of electricians. Disclosure of Interest None Declared

Introduction Fibrocartilaginous embolism (FCE) is a rare spinal cord infarction due to embolism of fibrocartilaginous material with consecutive arterial infarction of the anterior spinal artery. Physical activity with increased axial pressure is the underlying mechanism of the retrograde migration of primarily nucleus pulposus material into the arterial system of the spinal cord. The initial severity of the clinical symptoms is supposed to be a prognostic predictor of recovery and so far, no specific treatment recommendation exists.Methods We present a case of spinal cord infarction due to FCE after long and sporty mountain cycling (during 6 hours and 2500 altitude difference) with detailed clinical and radiological follow-up.Results The clinical and radiological follow-up at month 4 showed an unexpected almost complete recovery despite the extensive initial clinical impairment.Conclusion Mountain cycling has not yet been described as a specific trigger of FCE with spinal cord infarction. Further observation is necessary to show if the prolonged bent posture and core muscle imbalance in cycling, in addition to the Valsalva manoeuvre during physical effort, may contribute to FCE. It is unknown if prognosis of spinal cord infarction due to FCE differs from other causes of spinal ischaemia and if anticoagulation treatment presents a therapeutic option.

IntroductionThe colonization of patients by carbapenemase-producing Enterobacterales (CPE) has been associated with heightened mortality, especially in vulnerable individuals within intensive care units (ICUs). Our study aimed to comprehensively assess CPE prevalence among ICU patients across the Mediterranean region pre-COVID-19, conducting a multicenter prevalence study in the first quarter of 2019.MethodsWe collected clinical data and rectal or fecal samples from 256 ICU patients for CPE testing. Additionally, we performed whole-genome sequencing on 40 representative CPE strains to document their molecular characteristics.ResultsAmong the 256 patients, CPE was detected in 73 samples (28.5%), with prevalence varying from 3.3 to 69.0% across participating centers. We observed 13 colistin-resistant CPE strains, affecting three ICUs. Genetic analysis revealed highly diverse E. coli and K. pneumoniae strains, predominantly from international high-risk clones. Notably, blaOXA-48 and blaNDM-1 were the most prevalent carbapenemase genes. Molecular typing uncovered potential patient clusters in six centers. Significantly, longer hospital stays were associated with increased CPE carriage (p

BackgroundIn Tunisia, the number of cardiac implantable electronic devices (CIEDs) is increasing, owing to the increase in patient life expectancy and expanding indications. Despite their life-saving potential and a significant reduction in population morbidity and mortality, their increased numbers have been associated with the development of multiple early and late complications related to vascular access, pockets, leads, or patient characteristics. ObjectiveThe study aims to identify the rate, type, and predictors of complications occurring within the first year after CIED implantation. It also aims to describe the demographic and epidemiological characteristics of a nationwide sample of patients with CIED in Tunisia. Additionally, the study will evaluate the extent to which Tunisian electrophysiologists follow international guidelines for cardiac pacing and sudden cardiac death prevention. MethodsThe Tunisian National Study of Cardiac Implantable Electronic Devices (NATURE-CIED) is a national, multicenter, prospectively monitored study that includes consecutive patients who underwent primary CIED implantation, generator replacement, and upgrade procedure. Patients were enrolled between January 18, 2021, and February 18, 2022, at all Tunisian public and private CIED implantation centers that agreed to participate in the study. All enrolled patients entered a 1-year follow-up period, with 4 consecutive visits at 1, 3, 6, and 12 months after CIED implantation. The collected data are recorded electronically on the clinical suite platform (DACIMA Clinical Suite). ResultsThe study started on January 18, 2021, and concluded on February 18, 2023. In total, 27 cardiologists actively participated in data collection. Over this period, 1500 patients were enrolled in the study consecutively. The mean age of the patients was 70.1 (SD 15.2) years, with a sex ratio of 1:15. Nine hundred (60%) patients were from the public sector, while 600 (40%) patients were from the private sector. A total of 1298 (86.3%) patients received a conventional pacemaker and 75 (5%) patients received a biventricular pacemaker (CRT-P). Implantable cardioverter defibrillators were implanted in 127 (8.5%) patients. Of these patients, 45 (3%) underwent CRT-D implantation. ConclusionsThis study will establish the most extensive contemporary longitudinal cohort of patients undergoing CIED implantation in Tunisia, presenting a significant opportunity for real-world clinical epidemiology. It will address a crucial gap in the management of patients during the perioperative phase and follow-up, enabling the identification of individuals at particularly high risk of complications for optimal care. Trial RegistrationClinicalTrials.gov NCT05361759; https://classic.clinicaltrials.gov/ct2/show/NCT05361759 International Registered Report Identifier (IRRID)RR1-10.2196/47525

The COVID-19 pandemic led to sustained surveillance efforts, which made unprecedented volumes and types of data available. In Belgium, these data were used to conduct a targeted and regular assessment of the epidemiological situation. In addition, management tools were developed, incorporating key indicators and thresholds, to define risk levels and offer guidance to policy makers. Categorizing risk into various levels provided a stable framework to monitor the COVID-19 epidemiological situation and allowed for clear communication to authorities. Although translating risk levels into specific public health measures has remained challenging, this experience was foundational for future evaluation of the situation for respiratory infections in general, which, in Belgium, is now based on a management tool combining different data sources.