[Validation in literary Arabic among Tunisian soldiers of the Post-Traumatic Stress Disorder checklist for DSM-5]. / Validation en arabe littéraire chez les militaires tunisiens de la Post-Traumatic Stress Disorder checklist for DSM-5.

Introduction: post-traumatic stress disorder (PTSD) is a topical issue due to the increase in armed conflicts and terrorist attacks in recent decades. The PCL-5 scale is used to screen and monitor patients with PTSD. The aim of our work was to validate a literary Arabic version of this scale on a population of Tunisian soldiers. Methods: the translation of the PCL-5 scale into Tunisian literary Arabic was performed according to the back-translation technique described by Werner and Campbell and recommended by Brislin. Cross-cultural validation was conducted in 7 steps according to Vallerand's method. Data collection was conducted at the psychiatry department of the Military Hospital of Tunis from February 2019 to December 2020. Results: we recruited 300 military personnel, 150 of whom were followed for PTSD. Cronbach's alpha was 0.98 indicating good internal consistency. The study of inter-item correlations revealed a total Spearman index of 0.75. This index indicates a good homogeneity of the translated scale items. Construct validity was checked using the Kaiser-Meyer-Olkin index (K-M-O) and Bartlett's test of sphericity. The latter was significant (p<0.000), and the K-M-O index was 0.969, indicating that the correlations between the items were of good quality. Conclusion: our study showed that the Arabic version of the PCL-5 scale has satisfactory psychometric properties comparable to those of the original version.

Acceptability of COVID-19 vaccine: a cross-sectional study in a Tunisian general hospital.

INTRODUCTION: the year 2020 was marked by the COVID-19 pandemic that killed more than one million people. Several vaccines have been developed and vaccination campaigns started in December 2020. The objective of our study was to assess the acceptability of the COVID-19 vaccine by hospital staff. METHODS: cross-sectional study conducted on a representative sample drawn at random from the staff of the Military General Hospital of Tunis. Data was collected between August and September 2020 by a clinical psychologist. We studied the associations between the different characteristics of our population and the decision to accept or refuse vaccination against COVID-19. RESULTS: a total of 398 hospital staff agreed to answer our questionnaire. Our sample was composed of 9% (n=36) physicians, 0.9% (n=3) pharmacists, 41.3% (n=164) paramedics, 16.1% (n=64) cleaning staff and 32.7% (n=131) administrative staff. The rapid discovery of the vaccine was hoped by 97% (n=386). Vaccination was considered a means of collective protection by 84.7% (n=337). However, only 58% (n=231) agreed to be vaccinated by the COVID-19 vaccine. The main factors significantly associated with acceptance of the COVID-19 vaccine was previous influenza vaccination (aOR: 2.58, 95% CI 1.69-3.94; p=0.000). CONCLUSION: apprehension about vaccination does not appear to be sparing the future COVID-19 vaccine. Fear of vaccine side effects outweighs fear of the disease, even among hospital staff. To achieve vaccination coverage, several awareness and communication activities must be carried out.

Corticosteroids Versus Cyclosporine for Subepithelial Infiltrates Secondary to Epidemic Keratoconjunctivitis: A Prospective Randomized Double-Blind Study.

PURPOSE: To compare efficiency and tolerance between topical 0.5% cyclosporine A (CSA) and fluorometholone (FML) for subepithelial infiltrates (SEI) complicating epidemic keratoconjunctivitis. METHODS: We conducted a prospective double-blind randomized study involving 72 eyes with SEI. Thirty-eight eyes were treated with topical FML (FML group) and 34 eyes with CSA 0.5% eye drops (CSA group). Treatment was considered successful in case of SEI reduction and visual acuity improvement. Tolerance was evaluated by Schirmer test value, burning on eye drops instillation, and conjunctival injection. RESULTS: Baseline characteristics of both groups were similar (P > 0.05). After 3 months of the regimen, resolution of SEI was 3 times more observed in the FML group than that in the CSA group (P = 0.026). After 6 months, resolution of SEI was observed in 70% of the FML group and in 47% of the CSA group (P = 0.068). The recurrence of SEI was almost twice higher in the FML group than that in the CSA group (16% vs. 9%). FML was better tolerated during the first 3 months: a higher Schirmer test value (P = 0.0003), less burning on instillation (P = 0.242), and less conjunctival injection (P = 0.003). For the rest of the follow-up period, the 2 groups were comparable in tolerance. No ocular hypertension was noted. CONCLUSIONS: Epidemic keratoconjunctivitis can evolve favorably under both FML and CSA. The effect of FML is faster and CSA is more durable with fewer recurrences. Both are safe therapeutic options for long-term control of SEI.

Premature Birth, low Birth Weight and Birth Defects after assisted reproductive therapies. a 18-year comparative study.

BACKGROUND: As assisted reproductive therapies (ART) become more common in Tunisia, it was relevant to define the associated perinatal risks. The risk of multiple births and its correlate after ART were well admitted. We aimed to disclose whether ART were associated with increased perinatal risks in singletons and twins from ART comparatively with spontaneous conception. METHODS: A retrospective descriptive and comparative study including all newborns conceived by ART and admitted between 1998 and 2015 and spontaneous newborns selected randomly. We compared separately singletons and twins from ART and natural conception for premature birth (PB) and low birth weight (LBW). For birth defects (BD), we compared the two groups condensed. RESULTS: We identified 425 ART newborns and 322 controls. The risk of PB was statistically higher, in both ART singletons and twins than in controls. Among singletons, the use of ART was associated with statistically significant increased rates of LBW and VLBW. Among twins, this result was valuable only for VLBW. Newborns conceived with ART had a risk of BD that was three times higher than in controls. BD risk was statistically higher with ICSI (Intra Cytoplasm Sperm Injection), ovulation inductor and in vitro fertilization. BD risks were 2.4 times higher with ICSI than with all others therapies condensed. CONCLUSIONS: This study highlighted the increased perinatal risks even in singleton from ART comparatively with natural conception. The exact mechanisms underlying all these risks remain unclear. Further studies are required to prove the part of ART underlying parental factors, and sterility itself.

Homocysteine and inflammatory biomarkers plasma levels, and severity of acute coronary syndrome.

Recently, homocysteine and new inflamatory biomarkers are demonstrated to be involved in cardiovascular diseases. These risk factors are not well studied in acute coronary syndrome. We investigated the distribution of homocysteine and inflammatory markers in patients with acute coronary syndrome and evaluated the association between these parameters and severity of the disease. One hundred and twenty-two patients with acute coronary syndrome were recruited in the cardiac intensive unit care of military hospital of Tunis. Classic risk factors, lipid parameters, total homocysteine, HsCRP, IL-6 and TNFα were determined for all participants. We investigated the distribution of these parameters according to the number of diseased vessels in patients with acute coronary syndrome. Patients with three affected vessels showed significant elevated homocysteine, HsCRP, IL-6, TNF-α, total cholesterol, LDL-cholesterol and Lp (a) compared to those with one and those with two affected vessels. Homocysteine (OR = 1.14; 95%IC: 1.04-1.25; P = 0.006), TNF-α (OR = 1.27; 95%IC: 1.13-1.44; P = 10(-3)), HsCRP (OR = 1.09; 95%IC:1.03-1.16; P = 0.005) and IL-6 (OR = 1.15; 95%IC: 1.06-1.25; P = 0.001) were significant predictors of severity of the disease. We conclude that homocysteine and inflammatory biomarkers appear to enhance the degree of affected arteries and so the severity of coronary artery disease.

[Role of lumbar puncture for febrile seizure among infants under one year old]. / L'utilité de la ponction lombaire en cas de convulsion fébrile chez le nourrisson agé de moins d'un an.

BACKGROUND: Febrile seizure is a frequent cause of hospitalization. Its management remains problematic. According to the American Academy of Pediatrics, lumbar puncture, which is not devoid of risk, is strongly recommended in infants under 1 year. AIM: to define the utility of lumbar puncture in the management of febrile seizures in infants under 12 months and to identify risk factors of meningitis and to respond to this question: "lumbar punction should be done in which infant with febrile seizure?" PATIENTS AND METHODS: This retrospective study was conducted in the department of pediatrics B in the Children Hospital of Tunis on eight-year period (2000-2008). In all statistical tests, significance level was set at 0.05. RESULTS: One hundred and six cases were collected during the period of study. Seizures related to bacterial meningitis were seen in 11 cases (10%). We have separated two groups: GI infants presented bacterial meningitis, and G2 infants with febrile seizure. The comparison between the two groups G1 and G2 showed the following predictors factors of meningitis: age < or = 7 months (p = 0.035), partial seizure (p = 0.028), duration of seizure > 5 min (p < 0.001), recurrence of seizure in the same day(p = 0,006), neurological abnormalities p < 0.001), CRP > 20 mg/l (p = 0.03), hyponatremia < or = 125 mmol/l (p = 0.01). The risk of meningitis is very low: 3.1 x 10 -3, if this condition is met: infants older than 7 months, having a unique and short seizure < or = 5 min, and with a CRP < or = 20mg/l. CONCLUSION: If the infant is older than 7 months, presenting a unique, febrile and short (< or = 5 min) seizure, having a normal neurological examination with CRP < or = 20 mg/l, lumbar puncture should be discussed a case by case but an hospitalization for 24 hours is required for monitoring.