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La thérapie par Champ Électromagnétique Pulsé (CEMP) est un moyen de physiothérapie antalgique, dont l'efficacité sur l'arthrose et spécifiquement la gonarthrose n'est pas encore formellement prouvée. L'objectif de notre étude était d'évaluer l'efficacité de la CEMP sur la gonarthrose. Nous avons mené une étude longitudinale incluant des patients suivis dans le service de rhumatologie pour gonarthrose retenu selon les critères ACR 1986 [1]. Nous avons exclu les patients sous anti-inflammatoire non stéroïdiens, anti-arthrosiques à action lente ainsi que ceux porteur de prothèse des genoux ou ayant eu une viscosupplémentation ou une injection articulaire de corticoïdes durant les quatre derniers mois qui ont précédé l'inclusion. Seul le recours au paracétamol était autorisé durant l'étude. Nous avons collecté les données sociodémographiques et cliniques. Tous les patients ont eu, dans le service de médecine physique, un traitement par CEMP moyennant des impulsions magnétiques à basse fréquence, à raison de 3 séances par semaine. L'évaluation des paramètres suivants a été effectuée avant (T0) et après les séances à la fin de toutes les séances CEMP (T2) : 3 domaines de Womac : douleur, raideur articulaire et fonction. L'étude statistique a eu recours au logiciel SPSS. L'étude a inclus 30 patients atteints de gonarthrose, avec un âge moyen de 57,70 ± 16,37 ans [22–87]. Le sex-ratio était de 1,3 en faveur des hommes. Seuls trois patients étaient fumeurs, 61 % étaient hypertendus, 37 % diabétiques et 21 % présentaient une dyslipidémie. L'indice de masse corporelle moyen était de 29,13 ± 3,91 kg/m2 [22,40–36,70]. Parmi ces patients, 43 % étaient en surpoids et 33 % souffraient d'obésité. La durée moyenne des gonalgies à la date de l'inclusion était de 76,34 ± 131,53 mois [6–720]. L'examen clinique a révélé un genu-varum chez 40 % des patients, un genu-valgum chez 27 % et un genu-flessum chez 7 %. L'analyse des clichés radiographiques a montré, selon la classification de Kellgren et Lawrence [2] , une gonarthrose modérée chez 43,8 % des patients. Une amélioration significative des domaines Womac douleur (T0 : 203, 33; T1 : 157,33; p = 0,011), Womac fonction (T 0 : 487 ; T1 : 398, 33 ; p = 0,035) ainsi que la fréquence par semaine de la consommation de paracétamol (2,55 ; 0,97 ; p = 0,022) a été notée. En revanche, l'amélioration du domaine Womac raideur n'était pas significative (T0 : 31,67 ; T1 : 22,67 ; p = 0,144). Notre étude a montré des résultats prometteurs sur l'efficacité du CEMP sur la douleur et la fonction. Des investigations sur de plus larges populations et d'autres localisations d'arthrose sont nécessaires pour appuyer nos résultats. [ABSTRACT FROM AUTHOR]

Le diabète entraîne fréquemment une altération de l'équilibre et la stabilité des patients de par la rétinopathie et la neuropathie accroissant ainsi risque de chutes. Notre objectif était d'étudier la relation entre les anomalies de la statique plantaire et l'équilibre chez les patients diabétiques et d'identifier les facteurs de risque d'instabilité chez cette population. L'objectif principal était de démontrer la corrélation entre les anomalies de la statique plantaire et les troubles de l'équilibre chez les patients diabétiques. Le second objectif est d'identifier les facteurs de risque liés à l'instabilité et à l'augmentation du risque de chutes dans cette population. Il s'agissait d'étude transversale descriptive sur 3 mois. Nous avons procédé a un interrogatoire, un examen clinique, un examen podoscopique et un examen des chaussures. Nous avons procédé à une évaluation instrumentale de l'équilibre sur un appareil type WINPOSTURE, permettant d'évaluer les oscillations du centre de gravité dans le plan frontal et sagittal. Une analyse bivarié a été effectuée pour rechercher les facteurs favorisants les troubles de l'équilibre. Le seuil de signification a été fixé pour un p ≤ 0,05. Notre travail a inclus 30 patients diabétiques âgés de 60 ± 7,8 ans. Concernant le stade d'évolution : deux patients avaient une rétinopathie diabétique et trois avaient une neuropathie diabétique L'absence de contrefort dans les chaussures a été observée dans 73 % des cas, et 30 % des patients avaient une usure latérale des chaussures. Les examens cliniques ont révélé des hyperkératoses plantaires, des onychomycoses mycosiques, des griffes des orteils, et des talalgies dans 23 % des cas. L'examen sur podoscope a objectivé des troubles statiques dans 80 % des patients, notamment des pieds plats et valgus de l'arrière-pied dans 40 % des cas. L'instabilité de l'appui monopodal a été observée chez 64 % des patients. Le test de Tinetti a évalué le risque de chutes chez 11 patients. L'évaluation instrumentale a montré une exagération de la surface d'oscillation en condition yeux fermés et une déviation latérale accrue chez 26 patients. Une analyse statistique a révélé une relation significative entre le type d'assise plantaire et l'oscillation en condition yeux fermés (p = 0,036). Ces résultats suggèrent que les troubles de la statique plantaire sont associés à une diminution de la stabilité et augmentent le risque de chutes. Les anomalies de la statique plantaire sont fréquentes chez les diabétiques ce qui impacte significativement leur équilibre. Les anomalies plantaires tels que les pieds plats et valgus sont fortement liés à l'instabilité posturale et au risque augmenté de chutes. Ainsi une évaluation podologique et des interventions spécifiques pour améliorer l'équilibre et réduire les risques de chutes dans cette population seraient nécessaires. [ABSTRACT FROM AUTHOR]

De multiples programmes de rééducation sont proposés pour soulager les patients souffrant de lombalgie chronique. Notre objectif était de comparer l'efficacité de la rééducation isocinétique par rapport à un programme de kinésithérapie classique chez les lombalgiques chroniques. Il s'agissait d'une étude prospective comprenant deux groupes de 25 patients. Le premier groupe a bénéficié d'une rééducation isocinétique et le second groupe a bénéficié d'une kinésithérapie active. Les critères d'évaluation étaient la douleur, la mobilité rachidienne, l'extensibilité et la force musculaire isométrique et isocinétique, le retentissement fonctionnel et sur la qualité de vie, et l'état psychologique au début et à la fin des deux protocoles. Les deux groupes de l'étude étaient homogènes en termes d'âge, genre, poids, taille, ainsi que les catégories professionnelles et l'ancienneté. L'âge moyen de notre population était de 42 ans, avec une prédominance masculine. Soixante-dix-huit pour cent de nos patients étaient actifs, avec une ancienneté professionnelle moyenne de 15,4 ans. La douleur évoluait en moyenne depuis 45 mois. Au début de l'étude, tous les paramètres étaient sévèrement limités. À la fin de notre étude, nous avons constaté une amélioration de tous les paramètres, après la rééducation dans les deux groupes. L'intensité de la douleur évaluée par l'EVA a diminué de façon significative (p = 0,02 chez le 1er groupe, p = 0,01 chez le 2e groupe). La souplesse rachidienne lombaire et l'endurance musculaire ont également été améliorés. Test de Shirado (p = 0,04 chez le 1er groupe, p = 0,01 chez le 2e groupe) et test de Sorenssen (p = 0,02 chez le 1er groupe, p = 0,01 chez le 2e groupe). Cette amélioration a été confirmée par l'évaluation isocinétique. Les scores de Dallas, Québec et HAD ont été diminués de façon significative. Néanmoins cette amélioration était plus importante au niveau des paramètres d'extensibilité rachidienne et des rétractions musculaires pour la kinésithérapie active et plus importante au niveau de la force musculaire pour la rééducation isocinétique. Les deux méthodes avaient des effets semblables dans le traitement de la lombalgiechronique. Un programme de rééducation combinant les deux méthodes pourrait être encore plus efficace et donner de meilleurs résultats que ceux obtenus séparément. [ABSTRACT FROM AUTHOR]

La chute du sujet âgé représente un problème de santé majeur qui peut avoir de graves conséquences, pourtant sa prévention par le biais de l'éducation thérapeutique reste négligée. L'objectif de notre étude était d'identifier les facteurs de risques de chute chez les sujets âgés et d'évaluer l'efficacité de l'éducation dans sa prévention. Il s'agissait d'une étude prospective incluant 100 sujets âgés qui ont répondu à un questionnaire. Nous avons utilisé l'échelle ABC-s évaluant la confiance de la personne en son équilibre. Une éducation par rapport à la prévention des chutes et la façon de se relever d'une chute a été faite. L'âge moyen de notre population était de 72 ans avec une prédominance féminine de 66 %. Quatre-vingt-sept pour cent avaient une maladie chronique dont 52 % traités par plus de 3 médicaments. Soixante et onze pour cent avaient une crainte de tomber et 69 % avaient un antécédent de chute. Concernant les facteurs de risque de chute, 77 % avaient des douleurs articulaires, 76 % avaient une baisse de l'acuité visuelle, 42 % avaient un antécédent de fracture, 71 % avaient des escaliers chez eux. Seulement 41 % avaient confiance en leur équilibre avant l'éducation. Nous avons trouvé une corrélation significative entre le genre, les maladies chroniques, le nombre de médicaments, l'antécédent de chute, les douleurs articulaires, l'ostéoporose et l'hypotension orthostatique et la confiance en l'équilibre (p = 0,001, p = 0,005, p = 0,049, p = 0,041, p = 0,001, p = 0,014, p = 0,004). Sur une échelle de 0 à 10, nous avons demandé aux patients d'évaluer l'effet de notre intervention éducative sur le changement de leurs habitudes, les notes étaient de 8 à 10. Le dépistage des facteurs de risques de chute est primordial et l'éducation thérapeutique a toute sa place dans la prévention des chutes. [ABSTRACT FROM AUTHOR]

Introduction: Multiple sclerosis (MS) is a potentially disabling disease of the brain and spinal cord. Falls are a serious health concern for persons with MS (PwMS)., Aim: To determine the frequency and associated factors of falls in PwMS., Methods: A cross-sectional study was conducted in the Physical Medicine and Rehabilitation and Neurological Departments at the Military Hospital of Tunis between July and December 2022. Participants meeting the inclusion criteria completed a survey focusing on the prevalence and related factors of falls. In addition to the survey and a thorough clinical and functional examination, we used the 12-item MS Walking Scale (MSWS-12), the Fall Efficacy Scale International (FES-I), the Short Physical Performance Battery (SPPB), and the 10-meter walk test for clinical assessment of balance. A baropodometric platform was employed for instrumental assessment., Results: Thirty individuals with an average age of 33,6 [SD: 7,7], completed the survey with a mean Expanded Disability Status Scale = 2,5. Twenty-one patients reported falling at least once since the diagnosis. The MSWS-12 mean score was 61 % and the FES-I scored an average of 33.8. The average total score of the SPPB was 8. Total boli of corticosteroids prescribed during disease flare-ups (p=0,022), magnetic resonance imaging lesions of the basal ganglia (p=0,047), vestibular syndrome (p=0,048), MSWS-12 score (p=0,022), and the chair lift test of SPPB (p=0,018) were significantly associated with the prevalence of falling. No significant differences were observed for the instrumental assessment., Conclusion: Falls are frequent in PwMS. MSWS-12, the FES-I, and the SPPB, can be used by clinicians to predict potential fallers of the PwMS.

Background: Whether land- or aquatic-based rehabilitation is more effective in improving knee osteoarthritis (OA) is still unclear. This study assessed the effectiveness of aquatic-based treatments in patients with knee OA., Methods: The participants were divided into a land-based exercise group (G1, n=30) and a water-based exercise group (G2, n=30). The exercises were performed for 8 weeks. The primary endpoint was a response to physical therapy, defined as a 20% decrease in the summed score for the Western Ontario and McMaster Universities-Osteoarthritis Index (WOMAC) pain subscale from T1 (before the start of the rehabilitation program) to T2 (8 weeks later). The secondary endpoints included the Visual Analog Scale (VAS) for pain, WOMAC functional and stiffness subscales, Lequesne Index, and Medical Outcome Study Short Form (SF-12) for physical and mental health., Results: A 20% decrease in the summed WOMAC pain subscale score was noted in 33% of patients in G1 (n=10) and 93% in G2 (n=28) (P<0.001). VAS scores at walking decreased by 14% in G1 vs. 37% in G2 (P<0.001), WOMAC stiffness subscale decreased by 18% in G1 vs. 53% in G2 (P<0.001), and the Lequesne index decreased by 10% in G1 vs. 33% in G2 (P<0.001). Quality of life improvement was greater in G2 than in G1; SF-12 (physical) increased by 2.3 in G1 vs. 5.4 in G2 (P=0.023), and SF-12 (mental) increased by 6.3 in G1 vs. 10.9 in G2 (P=0.022)., Conclusion: Both aquatic and land-based exercises improved pain intensity, functional impairment, degree of handicap, and quality of life impairment caused by OA. However, the improvement was more significant in the aquatic-based exercises group.

Nearly 50 years after the ground-breaking isolation of the primary Comptonia peregrina microsymbiont under axenic conditions, efforts to isolate a substantial number of Protofrankia and Frankia strains continue with enduring challenges and complexities. This study aimed to streamline genomic insights through comparative and predictive tools to extract traits crucial for isolating specific Frankia in axenic conditions. Pangenome analysis unveiled significant genetic diversity, suggesting untapped potential for cultivation strategies. Shared metabolic strategies in cellular components, central metabolic pathways, and resource acquisition traits offered promising avenues for cultivation. Ecological trait extraction indicated that most uncultured strains exhibit no apparent barriers to axenic growth. Despite ongoing challenges, potential caveats, and errors that could bias predictive analyses, this study provides a nuanced perspective. It highlights potential breakthroughs and guides refined cultivation strategies for these yet-uncultured strains. We advocate for tailored media formulations enriched with simple carbon sources in aerobic environments, with atmospheric nitrogen optionally sufficient to minimize contamination risks. Temperature adjustments should align with strain preferences-28-29°C for Frankia and 32-35°C for Protofrankia -while maintaining an alkaline pH. Given potential extended incubation periods (predicted doubling times ranging from 3.26 to 9.60 days, possibly up to 21.98 days), patience and rigorous contamination monitoring are crucial for optimizing cultivation conditions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Gtari, Maaoui, Ghodhbane-Gtari, Ben Slama and Sbissi.)

Introduction: Chronic low back pain is a public health problem in view of its functional repercussions and the functional rehabilitation is an integral part of its management., Aim: To compare the evolution of muscle strentgh of spinal extensors and flexors in chronic low back pain patients after an isokinetic rehabilitation protocol and a conventional rehabilitation one., Method: This was a prospective and comparative study carried out in the Physical Medicine Department of the Tunis Military Hospital over a period of 7 months. Fifty patients were included, randomly divided into two groups of 25. The first group (G1) benefited from an isokinetic rehabilitation protocol and the second one (G2) from a classic active physiotherapy. We performed a clinical (Sorensen test and Shirado test) and isokinetic evaluation of the trunk muscles before and after rehabilitation., Results: The mean age of the general population was 42±8.6 years old. Clinical evaluation showed a deficit in the extensor and flexor muscles of the spine, more important in the extensors in both groups. After rehabilitation, there was a significant improvement in clinical tests of muscular endurance in G1 and G2. Isokinetic assessment showed a greater muscle deficit in the extensors in both groups. After isokinetic rehabilitation, peak torque for flexors and extensors increased by 21% and 23% respectively, power was 34% and 37% higher, and total work increased by 26% and 47%. On the other hand, the (F/E) ratios were unchanged for all three speeds. In Group 2, peak torque values for flexors and extensors increased by 22 and 15% respectively, power was higher by 31 and 23% and total work was also up by 29 and 17%, while F/E ratios were also unchanged. Group 1 showed the greatest improvement in extensor strength at 60°/s, and in power at 90°/s for the various muscles., Conclusion: In our study, we concluded that endurance and muscular strength improved the most after isokinetic rehabilitation.

Introduction: Stump hyperhidrosis is a common condition after lower limb amputation. It affects the prosthesis use, and the quality of life of patients. Several case reports tried to prove benefit of using Botulinum toxin in its treatment., Aim: This study was to conduct a larger workforce clinical trial and to demonstrate benefits of botulinum toxin injection in the treatment of stump hyperhidrosis., Methods: A prospective study was conducted. War amputees who complained of annoying excessive sweating of the stump were included. They received intradermal injection of botulinum toxin A in the residual limb area in contact with prosthetic socket. Abundance of sweating and degree of functional discomfort associated with it were assessed before, after 3 weeks, 6 and 12 months., Results: Seventeen male patients, followed for post-traumatic limb amputation were included in the study. Discomfort and bothersome in relation to Hyperhidrosis did decrease after treatment (p<0,001). Reported satisfaction after 3 weeks was 73,33%. Improvement of prothesis loosening up after 3 weeks was 72,5% [±15,6]. Mean injection-induced pain on the visual analogue scale was 5.17/10 (±1.58). The mean interval after the onset of improvement was 5.13 days [min:3, max:8]. The mean time of improvement was 10.4 months after the injection [min:6, max:12]. No major adverse events were reported following treatment., Conclusion: Intradermal injections of botulinum toxin in the symptomatic treatment of stump hyperhidrosis are effective and have few adverse effects. It improves the quality of life of our patients thanks to a better tolerance of the prosthesis.

Introduction: Cerebral palsy (CP) is a group of permanent disorders of the development of movement and posture causing activity limitation., Aim: To evaluate the epidemiological, clinical, and radiological profile of children with CP and to study the therapeutic modalities in daily clinical practice., Method: This was a retrospective, descriptive study, carried out in a physical medicine and rehabilitation department, including all the patients referred with the diagnosis of cerebral palsy between January 2000 and December 2016. We used pre-established records to collect data. The missing data were collected from the files of the pediatric department. To classify cerebral palsy, we used a motor impairment classification, topographic classification according to the affected limb and the GMFCS - ER., Results: Fifty patients were included with a gender ratio of 1.23. The mean age of patients was 7.8 years old. The risk factors for CP were mainly represented by perinatal asphyxia (55%) and prematurity (37%). The spastic form was predominant (74%). Quadriplegia was the most severe clinical form (61%). Neuro-orthopedic deformations were found in 78% of cases. Half of the children had GMFCS score between 1 and 2. Brain MRI lesions were dominated by anoxic-ischemic sequelae (34%). Physical therapy was prescribed for all patients. The most prescribed devices were the dynamic ankle foot orthosis (60%). Baclofen was prescribed in 5% of cases and botulinum toxin injection was performed in 30% of children., Conclusion: The cerebral palsy defines the clinical and functional disorders caused by non-progressive developmental damage to the brain of the infant which requires a multidisciplinary management.

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Introduction: Osteoarthritis (OA) is the most common degenerative joint disease in the elderly. The often multifocal location at this age can be a source of pain, limitation of everyday activities, thus affecting their quality of life., Aim: To evaluate functional status of aged people with generalized OA in Tunisia, and to detect the main factors associated with a poor function in order to optimize their medical care., Methods: A cross-sectional, descriptive study done between January and March 2017. Fifty patients were included, aged 65 years and over followed for generalized osteoarthritis. The functional repercussions of polyarthrosis was assessed by functional independence measure (FIM), the Lequesne Algofunctional Index, the Womac index for hip and knee OA, and the Oswestry questionnaire for low back pain., Results: The mean age of patients was 71.94 ± 0.8 years with a sex ratio of 0.42.The functional status of patients with polyarthrosis were altered to varying degrees. The most impaired dimensions of FIM were self-care, transfers and locomotion. Activities of daily living of the Lequesne index was the most impaired section with an average of 5.28. The three dimensions of the Womac index were affected, particularly the pain section with an average of 49.18/100. The Oswestry index was altered with an average of 18.89 / 40. Factors associated with poor functional status were: Female gender (p<0,05), age of development (p<0,05), spinal arthrosis (p<0,05) and history of falls(p<0,05)., Conclusion: Polyarthrosis is accompanied by functional impairment in the elderly. Factors associated with functional impairment should be considered in the Patient Management Program.

Introduction: functional restoration of the spine is a proven method in the short-term management of chronic low back pain. The aim of our study  was to evaluate the effect of a functional restoration program at two years of evolution., Methods: retrospective study of patients enrolled in a functional restoration program during 2014 and summoned after two years,  in 2016. Patients have had the same clinical and functional evaluation before the program, at five weeks and  at two years., Results: Thirty patients were enrolled in the study. The average age was 45 years. Eighty % of the patients were overweight. Significant improvement for all clinical and functional parameters at five weeks was noted. This gain was maintained significantly for some parameters at two years., Conclusion: The results of the functional rehabilitation of the spine are satisfactory at two years of evolution.

Background: In sport, the nature of ground surface is likely to influence the contribution of visual information on postural control. Boxing and wrestling are respectively practiced on firm and soft ground surfaces. The aim was to compare the postural control of boxers with that of wrestlers on stable (firm) and unstable (soft and dynamic) ground surfaces, with and without deprivation of vision., Methods: Fifteen male international boxers and 15 male international wrestlers presenting the same anthropometrics characteristics and the same number of years of sports practice were recruited. Spatiotemporal parameters of displacement of the center of feet pressure (COP) were measured on a force platform in static (firm and foam surfaces with eyes open and eyes closed) and dynamic conditions (medio/lateral and antero-posterior directions with eyes open and eyes closed)., Results: The results mainly showed a significant vision × group interaction in the antero-posterior direction for the dynamic postural condition (P<0.017). This indicated that the contribution of visual information was greater for the boxers than for the wrestlers in challenging condition (P=0.030)., Conclusions: Further studies are needed to confirm whether the nature of ground surface influences the contribution of visual information, which can be, in turn, affected by the specificity of motor skills.

Background: During football several joints are greatly demanded, especially the knees.The interest of the isokinetic is to detect an imbalance between agonist and antagonist muscles of the muscle leg and between dominant and non dominant leg, in order to prevent injuries and to improve the physical fitness of young soccer players., Aim: evaluate the isokinetic profile of flexor and extensor muscles of the knee of competitive footballers Methods : Prospective study conducted in the department of Physical and Rehabilitation Medicine of the Military Tunis Hospital, including 15 competitive footballers and evaluated during the month of August 2012. All patients underwent an isokinetic assessment of agonist and antagonist muscles of the knees in concentric mode 3 speed 60 ° / 120 ° and 180 ° (with analysis of figures and curves), using a Biodex dynamometer. The selected parameters were the time of maximum force (MFM) of the knee flexors and extensors, and the agonists / antagonists ratio (IJ / Q). The data were analyzed by SPSS software., Results: 15 competitive footballers were included. The average age is 23.20 years ± 3.99 years, ranging from 18 to 28 years. The average size is 167.13 cm ± 3.6 cm with a range of 163 and 172 cm. The average weight is 60.87 kg ± 5.97 with a range of 50 to 70 kg. The isokinetic evaluation showed a statistically significant superiority of the flexor muscles of the right knee compared with those of the left knee at the speed 60 / s (p = 0.046) and 120 / s (p = 0.031), whereas this difference has not been found for the extensors muscles. The values of the ratio of quadriceps to hamstring increases with the speed of movement performed, the maximum moment / weight moving in the opposite direction., Conclusion: The isokinetic evaluation allows an objective assessment of the flexor and extensor muscles of the knee footballers, in order to correct imbalance and preserve the sporting future of the young footballers.