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Abstract Background Parkinson’s disease (PD) substantially contributes to poor functional outcomes, loss in productivity, and poor health-related quality of life (HRQoL). Despite the existence of various scales, there is a notable gap in existing HRQoL reviews with regard to the availability of Arabic validated scales. As a response to this gap, the aim of our scoping review is to identify validated scales, focusing on their psychometric validation procedures, to contribute valuable insights to the understanding of HRQoL among the Arabic-speaking people with PD. Methods A scoping review was conducted at the end of December 2022, using the Medline and Embase databases. The focus of this review was on examining the psychometric properties and validation procedures of included scales. Articles were included in the full-text screening process if they focused on people with PD of any age, included a scale measuring HRQoL in Arabic, and were written in English, French, or Arabic. Results After applying inclusion/exclusion criteria, 10 studies were selected to analyze HRQoL scales validated in people with PD. However, the PDQ-39 is the only HRQol PD specific scales validated in the Arabic language. Five studies validated in people with PD were identified in the context of instrument validation (3 generic, 1 specific validated in 2 studies). Conclusion There are several HRQoL measurement scales for people with PD. However, only one specific HRQoL instrument has been validated in Arabic for people with PD. For the remaining instruments identified they were just used in people with PD without being validated in this population.

IntroductionIntermittent fasting (IF) represents a dietary intervention similar to caloric restriction, characterized by the strategic limitation of food consumption. Among the diverse array of practices for IF, Ramadan IF (RIF), a religious observance in Islam, mandates that healthy adult Muslims abstain from both food and drinks during daylight hours. In sports, researchers have extensively studied IF effects on health, including sleep and physical performance, but its impact on cognitive functions during RIF remains understudied. Therefore, this study was conducted to evaluate the influence of RIF on psychomotor and cognitive performance among young female athletes.MethodsTo achieve this purpose, a cohort of 23 female handball players, aged 17.2 ± 0.5 years, participated in a series of six testing sessions: one conducted prior to Ramadan (R0), and others during the first (R1), second (R2), third (R3), and fourth (R4) weeks of Ramadan, followed by a session in the week after Ramadan (R5). Each session involved assessments using a Simple Reaction Time Test (SRT), Choice Reaction Time Test (CRT), Vigilance Test (VT), and Mental Rotation Test (MRT). Additionally, dietary intake, body composition, and Pittsburgh Sleep Quality Index (PSQI) scores were evaluated during these periods.Results and discussionThe obtained data illustrated that there was a decrease in SRT, CRT, VT, and MRT performances during R1 in comparison to R0 (all p

Objectives: Wild birds are vectors of antimicrobial resistance. Birds living in close contact with humans or other animals, like feral pigeons (Columba livia), might be especially prone to acquire resistance genes such as those encoding extended-spectrum beta-lactamases (ESBLs) and carbapenemases. Methods: Cloacal samples (n = 206) of free-living feral pigeons (C. livia) were collected in Sousse and Monastir, Tunisia. Antimicrobial susceptibility profiles were determined by disc-diffusion, and resistant isolates were short- and long-read whole-genome sequenced. Sequence analysis was performed using tools of the Centre for Genomic Epidemiology, and Phylogenetic analysis was performed based on the core-genome MLST. Results: Fourteen (14/206, 6.8%) pigeons harboured Enterobacterales resistant to last-generations cephalosporins, of which 10 were CTX-M-15- or CTX-M-27-producers, while two (1.0%) carried a VIM-2-producing Pseudomonas putida. Positive pigeons lived on four different livestock farms. Three STs (ST206, ST5584, ST8149) were identified among E. coli, of which ST5584 and ST8149 were found in two different farms. Genetic diversity was also observed in Enterobacter cloacae and P. putida isolates. The blaCTX−M-27 genes were chromosomally encoded, while the blaCTX−M-15 genes were carried on highly similar IncF/F-:A-:B53 plasmids. The blaVIM-2 gene was located on a class 1 integron co-harbouring several resistance genes. Conclusion: Pigeons living on livestock farms carried clinically important resistance genes encoding ESBLs and carbapenemases. Our results evidenced that both clonal (ST8149 and ST5584) and plasmidic (IncF/F-:A-:B53) transfers played a role in the spread of resistance genes among pigeons. Further studies are needed to identify factors favouring the transfer and persistence of resistance genes within the pigeon communities.

Abstract Background In Tunisia, the prevalence of diabetes mellitus increased from 15.5% on 2016 to 23% by 2023. While Chronic Kidney Disease (CKD) stills the most dreaded complications of diabetes, studies on the prevalence of chronic kidney disease non-dialysis diet are scarce. The aim of this study was to assess the prevalence of chronic kidney disease among the Tunisian diabetic population based on investigators’ specialty, demographic criteria (gender, age, duration of diabetes and geographic distribution) and diagnosis criteria (albuminuria and/or eGFR). Methods This observational, multicentric, and cross-sectional study enrolled all diabetic subjects from all regions of Tunisia with at least 3 months of follow-up before the inclusion date, from 09 January to 08 February 2023. CKD diagnosis was established based on the KDIGO guidelines. The study was carried out at medical departments and ambulatory clinics of different healthcare providers. Baseline data were collected by investigators using an electronic case report form (eCRF). Continuous variables were described by means, median, standard deviation, and quartiles. Categorical data were tabulated in frequencies and percentages. Results The overall prevalence of CKD among the 10,145 enrolled patients with diabetes mellitus was 38.7% with a 95%CI [37.8-39.6%]. 50.9% were male, with a mean age of 67.5 (± 11.3) years. The mean diabetes duration was 16.1 years (± 8.9). The highest CKD prevalence was noted among nephrologists (82.2%), while it was similar between the cardiologists and the primary care physicians (30.0%). CKD prevalence was highest among males (43.0% versus 35.1%) and increased proportionally with patients’ age and diabetes duration. CKD was more frequent in the Mid-East Area when compared to other regions (49.9% versus 25.3 to 40.1% in other regions). Albuminuria was present within 6.6% of subjects with CKD, and it was found an estimated glomerular filtration rate (eGFR)

This study adapted and validated the How I Think Questionnaire (HIT-Q), intending to develop an Arabic version of the measure. The study assessed the (a) factorial structure of the Arabic version of the How I Think Questionnaire (A-HIT-Q), (b) construct validity evidence of the A-HIT-Q based on the internal structure of the scale, and (c) criterion validity evidence, highlighting how the cognitive distortions measure relates to some key theoretical variables such as depression. This study involved 762 Tunisian students aged 15–22 years, using a non-probabilistic sampling method. The students were boys (n = 297) and girls (n = 465). They completed self-report forms on Arabic-HIT-Q, depression (HADS), sleep (ISI), and physical activity participation, adhering to all relevant ethical considerations. Exploratory analysis revealed four factors which accounted for 73.46% of the variations in the distortion measure. Reliability analysis showed good internal consistency (α = 0.915) and temporal stability (r = 0.879). Criterion validity evidence showed cognitive distortion (as measured with the A-HIT-Q) was significantly associated with physical activity participation, anxiety, depression, and insomnia. However, no significant relationship has been observed between cognitive distortion, age, gender, and study levels. The evidence gathered supports the utility of the A-HIT-Q. Thus, the instrument demonstrates high efficacy in assessing the levels of cognitive distortions among adolescent students residing in Arabic-speaking regions.

Abstract The co‐occurrence of sensorineural hearing loss and male infertility has been reported in several instances, suggesting potential shared genetic underpinnings. One such example is the contiguous gene deletion of CATSPER2 and STRC genes, previously associated with deafness‐infertility syndrome (DIS) in males. Fifteen males with both hearing loss and infertility from southern India after exclusion for the DIS contiguous gene deletion and the FOXI1 gene mutations are subjected to exome sequencing. This resolves the genetic etiology in four probands for both the phenotypes; In the remaining 11 probands, two each conclusively accounted for deafness and male infertility etiologies. Genetic heterogeneity is well reflected in both phenotypes. Four recessive (TRIOBP, SLC26A4, GJB2, COL4A3) and one dominant (SOX10) for the deafness; six recessive genes (LRGUK, DNAH9, ARMC4, DNAH2, RSPH6A, and ACE) for male infertility can be conclusively ascribed. LRGUK and RSPH6A genes are implicated earlier only in mice models, while the ARMC4 gene is implicated in chronic destructive airway diseases due to primary ciliary dyskinesia. This study would be the first to document the role of these genes in the male infertility phenotype in humans. The result suggests that deafness and infertility are independent events and do not segregate together among the probands.

To date, no research has examined the relationship between sexual self-esteem, body self-esteem, psychological distress, marital satisfaction, and engagement in physical activities. Through a study involving 443 adults the aim of this research was to analyze the connections between engaging in physical activities, body self-esteem, sexual self-esteem, marital satisfaction, and psychological distress among adults. The results obtained through Partial Least Squares (PLS) modeling with SmartPLS reveal significant interconnections among these variables. The correlation between body self-esteem and psychological distress, the positive relationship between sexual satisfaction and positive sexual self-esteem, as well as the beneficial influence of engaging in physical activities on marital satisfaction, are key highlights of this study. The robustness of the measures, confirmed by high coefficients, strengthens the credibility of the results. Despite these advancements, the cross-sectional nature of the study emphasizes the need for longitudinal research to gain a deeper understanding of psychological and relational dynamics over time. In conclusion, this study offers significant contributions to promoting balanced marital relationships, highlighting the importance of considering body and sexual self-esteem, psychological distress, and physical activity within the context of human relationships.

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

Abstract Background Heart failure (HF) is a serious and frequent pathology. It represents a major public health problem. We have few data about this pathology in our country. The aim of our study is to determine the epidemiological, clinical, therapeutic, and prognostic characteristics of new-onset HF with reduced left ventricular ejection fraction (HFrEF) and to study the degree of conformity of the management of HF with international recommendations. Results Our study population includes 210 patients hospitalized for HFrEF newly diagnosed. The average age of our patients was 64 ± 12 years. A male predominance was noted with a sex ratio of 2.8. The main etiology of HF was ischemic heart disease noted in 97 patients (46.2%). The average LVEF is 33 ± 6%. The triple combination (angiotensin-converting enzyme inhibitors + beta blockers + Mineralocorticoid Receptor Antagonists) was prescribed in 75 patients (35.7%). The quadruple combination (angiotensin-converting enzyme inhibitors + beta blockers + Mineralocorticoid Receptor Antagonists + Sodium-Glucose Co-Transporter 2 inhibitors) was prescribed in 17 patients (8.1%). Myocardial revascularization was indicated in 97 patients (46.6%) and valve surgery was indicated in 49 patients (23.3%). Hospital mortality was 3.8% and at 1 year 18.1%. Among the 192 patients followed during the first year after discharge from hospital, 81 patients had to be re-hospitalized, i.e., a 1-year rehospitalization rate of 42.2%. Conclusions Our study highlighted the epidemiological and clinical features of HF in a Tunisian care center, revealing our patient management deficiency. This pushes us to have a new Tunisian register to enable a better statistical analysis and lead to more relevant conclusions.

Abstract Objective The present study examined the impact of academic engagement, study processes, and grit on the academic achievement of physical education and sport university students. Methods An internet-based survey recruited 459 university students aged 19–25 years (M = 21 ± 1.3) in physical education and sports (PES) to fill out questionnaires on Physical Education-Study Process Questionnaire (PE-SPQ), Physical Education-Grit (PE-Grit), academic engagement (A-USEI), and Grade Point Average (GPA). A path analysis was carried out to understand variable relationships. Results Data from each variable exhibited symmetrical and normal distribution, as indicated by the skewness and kurtosis values. The model’s fit indices showed sufficient Comparative Fit Index (CFI = 0.92), Tucker-Lewis Index (TLI = 0.90), Goodness of Fit Index (GFI = 0.99) and Normed Fit Index (NFI = 0.90) and showed acceptable levels. The results indicated a statistically significant positive impact of engagement (β = 0.299, p

This paper investigated the relationships of some physical and mechanical parameters of sediments and a typical clay during a natural dewatering process. Four sediments from different French river dams sampled by the Électricité De France group (EDF group) and a commercial kaolin clay used for comparative purposes were the focus of this study. Continuous dewatering was monitored in a laboratory by quantifying the percentage of water remaining in sediments or clay, drained and evaporated. Undrained shear strength was also assessed during the sediment or clay dewatering process, using the laboratory vane shear test. The samples were controlled along different dimensions during the dewatering process throughout the whole experiment. The results showed a certain interdependence between the physical parameters and the water content (ω), which was normalized by the liquidity limit (ω/LL) over time. This led to sigmoidal and exponential correlations when considering the percentage of water drained. The percentage of water remaining in the sediments or clay was characterized using the normalized water content, leading to exponential and power correlations. Both exponential and linear correlations were perfect for describing the evolution of the percentage of water evaporated. Other correlations were established for variations in void index, dry unit weight/solid unit weight ratio and undrained shear strength during the dewatering process.

In the era of ubiquitous computing, the challenges imposed by the increasing demand for real-time data processing, security, and energy efficiency call for innovative solutions. The emergence of fog computing has provided a promising paradigm to address these challenges by bringing computational resources closer to data sources. Despite its advantages, the fog computing characteristics pose challenges in heterogeneous environments in terms of resource allocation and management, provisioning, security, and connectivity, among others. This paper introduces COGNIFOG, a novel cognitive fog framework currently under development, which was designed to leverage intelligent, decentralized decision-making processes, machine learning algorithms, and distributed computing principles to enable the autonomous operation, adaptability, and scalability across the IoT–edge–cloud continuum. By integrating cognitive capabilities, COGNIFOG is expected to increase the efficiency and reliability of next-generation computing environments, potentially providing a seamless bridge between the physical and digital worlds. Preliminary experimental results with a limited set of connectivity-related COGNIFOG building blocks show promising improvements in network resource utilization in a real-world-based IoT scenario. Overall, this work paves the way for further developments on the framework, which are aimed at making it more intelligent, resilient, and aligned with the ever-evolving demands of next-generation computing environments.

Enterobacterales resistant to extended-spectrum cephalosporins (ESC) are a marker of the antimicrobial resistance (AMR) burden. They are infecting humans, but the intestinal microbiota can also be transiently colonized without developing symptoms. Healthy carriage can promote silent dissemination of resistant bacteria, and data on this colonization are often lacking. Between 2021 and 2023, a sampling of healthy Tunisian people was carried out. Fecal samples (n = 256) were plated on selective agar, and all collected isolates were characterized by phenotypic (antibiograms) and genomic (whole-genome sequencing) methods. A total of 26 (26/256, 10.2%) isolates were collected, including 24 Escherichia coli and 2 Klebsiella pneumoniae. In total, 17 isolates (15 E. coli and 2 K. pneumoniae) presented an ESBL phenotype conferred by the blaCTX-M-15 gene, and 9 E. coli isolates presented an AmpC phenotype conferred by the blaDHA-1 gene. K. pneumoniae belonged to ST1564 and ST313, while E. coli belonged to diverse STs including the pandemic ST131 clone. Clonally related ST349 E. coli isolates carrying the blaDHA-1 gene were found in nine individuals. In parallel, four blaCTX-M-15 -positive E. coli isolates carried this ESC-resistance gene on an epidemic plasmid IncF/F-:A-:B53 previously identified in Tunisian pigeons and fish. These findings highlight the spread of genetically diverse ESC-resistant Enterobacterales as well as an epidemic plasmid in Tunisia, emphasizing the need for antimicrobial stewardship to limit the transmission of these resistances in the Tunisian population.

The present study validated the University Student Engagement Inventory (USEI) in the Arabic language (A) by assessing its factor structure, construct validity, reliability, and concurrent validity. A total of 864 Tunisian Physical Education and Sport students provided data which was used to perform exploratory and confirmatory factor analyses, using samples comprising 366 (aged 19–25 years) and 498 (aged 19–26 years) students, respectively. The A-USEI, grade-point average (GPA), and Physical Education Grit (PE–Grit) scales were completed via online surveys. The exploratory factor analysis revealed that the A-USEI had three dimensions. The confirmatory factor analysis indicated that the second-order model was more suitable than the first-order multi-factor model. Using the indicators for the second-order model, the three factors showed good reliability, with their average variance extracted (AVE) values reflecting sufficient validity. The correlation analyses between the two scales’ scores and the A-USEI scores showed a moderate correlation, confirming the adapted scale’s concurrent validity. The study concludes that A-USEI is a valid tool for assessing student engagement among Arabic students. In addition, the practical implications and directions for future research are discussed.

Background. COVID-19 is the major cause of serious acute respiratory complications, leading to strong perturbation of cytokine release and high levels of interleukin-6. In this work, we assessed the efficacy and safety of Tocilizumab in Tunisian patients with severe COVID-19. Materials and Methods. We enrolled in this retrospective study 255 critically ill patients in the intensive care unit of the military hospital of Tunis. These patients were categorized into a standard group (n = 148) and a Tocilizumab group (n = 107). Medical records were gathered and analyzed between September, 2020 and September, 2021. Results. No significant difference was detected in clinical and biological parameters at admission between the two studied groups. Interestingly, we revealed here a significant improvement in respiratory parameters as well as biological findings such as hemoglobin (p=0.001), platelets (p=0.005), CRP (p=0.0001), fibrinogen (p=0.0001), and creatinine (p=0.002). Regarding the Simplified Acute Physiology Score II and 28-day mortality, we showed a significant decrease of these two parameters following 48 hr of drug administration (p=0.0001, respectively). No significant difference between the two groups regarding complications except the renal failure and the need for renal replacement therapy, which are higher in the standard group as compared to patients treated with Tocilizumab (p=0.02; p=0.0001, respectively). Conclusions. Treatment with TCZ seems to be safe and effective in reducing the mortality rate in severe COVID-19 patients.