Major mistakes in scientific medical writing based on manuscripts' reviews.

INTRODUCTION: Peer review is a crucial process in ensuring the quality and accuracy of scientific research. It allows experts in the field to assess manuscripts submitted for publication and provide feedback to authors to improve their work. AIM: To describe mistakes encountered while peer reviewing scientific manuscripts submitted to "La Tunisie Médicale" journal. METHOD: This was a bibliometric study of research manuscripts submitted to "La Tunisie Médicale" and reviewed during 2022. The data collected included the type of the manuscripts and the number of reviews conducted per manuscript. The study also identified variables related to writing mistakes encountered during the peer review process. RESULTS: A total of 155 manuscripts (68% original articles) were peer reviewed and 245 reviews were delivered, by two reviewers. Out of 62 mistakes detected, 21% concerned the results section. In 60% of the manuscripts, the keywords used were not MeSH (Medical Subject Headings) terms. The introduction lacked in-text citations in 30% of the reviewed manuscripts, while the method section did not have a clear study framework (27%). The two major mistakes detected in the results section were the misuse of abbreviations in tables/figures, and the non-respect of the scientific nomenclature of tables/figures with respectively 39% and 19% of manuscripts. CONCLUSION: This study identified 62 mistakes while reviewing scientific manuscripts submitted to "La Tunisie Médicale" journal. Scholars can benefit from participation in scientific writing seminars and the use of a safety checklist for scientific medical writing to avoid basic mistakes.

Factors associated with anxiety and depression in men undergoing fertility investigations: a cross-sectional study.

BACKGROUND: Infertility is a real public health issue because of its medical, socio-cultural, and financial impact. It does also have heavy psychological consequences on both partners. This study aimed to assess levels of anxiety and depression among men undergoing infertility investigation and to identify their associated factors. METHODS: We conducted a cross-sectional study in the Laboratory of Cytogenetics and Reproductive Biology of Fattouma Bourguiba University Teaching Hospital (Monastir, Tunisia) between August 30th, 2020, and March 16th, 2021. Anxiety and depression levels were assessed using the valid Arab version of the Hospital Anxiety and Depression scale (HAD). Semen parameters were analyzed and interpreted according to 2021 World Health Organization (WHO) guidelines. RESULTS: A total of 282 men were included in the current study. The mean HAD-D (depression) and HAD-A (anxiety) scores were of 6.56 ± 3.07 (IQR [4-8]) and 7.94 ± 3.73 (IQR[5-10]) respectively. Univariate analysis showed that patients having two or more comorbidities were nearly five times more likely to be anxious than those without or with only one comorbidity (ORc = 4.71; p = 0.007). Furthermore, single patients were about four times more anxious than those in couple having primary or secondary infertility (ORc = 3.85; p = 0.027). With regards to semen parameters, patients having hypospermia were more than two times anxious compared with those with normal semen volume (ORc = 2.33; p = 0.034). As for depression, we observed that patients with an infertility history lasting for a year or more have a nine times greater risk of depression (ORc = 9.848; p = 0.007). With regards to semen parameters, patients exhibiting two or more semen abnormalities, teratozoospermia and increased MAI were more depressed (ORc = 2.478; p = 0.036; ORc = 2.549: p = 0.023; ORc = 2.762; p = 0.036). Furthermore, we found a negative correlation between HAD-A scores and patient's age. CONCLUSIONS: We pointed out through the current study the associated factors with anxiety and depression in patients under fertility management to precociously identify those who need psychological counseling and hence to better manage infertility issues.

Prevalence and impact of diabetes mellitus in hospitalized COVID-19 patients in a Tunisian Center: a cross-sectional study.

Background: The outbreak of the coronavirus disease 2019 (COVID-19) has become an evolving worldwide health crisis. With the rising prevalence of diabetes mellitus has come an increasing awareness of their impacts on infectious diseases, and the risk for postinfection complications and mortality from critical infections. Objective: The objective of this study was to evaluate the prevalence and impact of diabetes mellitus on the severity and mortality of COVID-19. Methods: Data of laboratory-confirmed hospitalized patients at the COVID-19 unit between September 2020 and August 2021 were analyzed, in a cross-sectional study. The population was classified into two groups: COVID-19 patients with and without diabetes. Primary outcomes were the overall length of hospital stay, the admission to the ICU, and death. The association between diabetes and death was assessed in a Cox proportional hazards model. Results: A total of 866 patients were included. There were 270 (31.2%) patients with diabetes. Diabetic patients were more likely to have hypertension (58.1 vs. 33.4%), cardiovascular disease (18.5 vs. 10.4%), and dyslipidaemia (17.8 vs. 7.2). Overall, 263 patients died, among them only 86 in the diabetic group (P=0.523). Patients with diabetes had a higher risk of developing complications (P<0.001). Multivariate Cox regression analysis showed that diabetes was not significantly associated with death [HR (95% CI): 1.253 (0.963-1.631)]. Conclusion: Diabetes was associated with a greater risk of complications in patients with COVID-19. Special attention to diabetic patients during treatment must be given to avoid these complications.

Prevalence of comorbid asthma in Tunisian patients with COVID-19: clinical features and outcomes.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has resulted in around 1 million COVID-19 infection cases and over 29,000 deaths in Tunisia thus far. There is great variability in the prevalence of asthma among patients with COVID-19, but the impact of asthma on patients with COVID-19 is not clear. We sought to describe the clinical features of Tunisian patients with COVID-19 and to compare asthmatic and non-asthmatic patients. METHODOLOGY: This retrospective study included 675 Tunisian patients who were hospitalized with COVID-19. Clinical characteristics were collected from medical records. Bivariate analyses and multivariate regression models were used to assess the associations between asthma and the risk of severe symptoms, including death/recovery. RESULTS: The prevalence of asthma in the sample was 14.5%. The results show that asthmatic patients with COVID-19 have significantly less severe symptoms and better outcomes than non-asthmatic patients. CONCLUSIONS: Asthma was not found to be associated with higher severity or worse prognosis among patients with COVID-19 in Tunisia.

Patients' perception of the quality of care at the Ibn Al Jazzar University Hospital in Kairouan, Tunisia.

AIM: This study aims to evaluate the level of satisfaction of patients hospitalized at Ibn Al Jazzar University Hospital of Kairouan in 2018. METHODS: It's a descriptive cross-sectional study including all patients hospitalized at Ibn Al Jazzar University Hospital in Kairouan over a period of three months, from January 1 to March 31, 2018. The survey was conducted using a questionnaire made up of 27 items to explore seven specific dimensions of satisfaction. RESULTS: A total of 640 patients was included in the study. The overall satisfaction rate was 41.7%. The dimensions of globality and hospital stay were the least appreciated by hospitalized patients with respective satisfaction rates of 14.4% and 18.3%. Access to care was the most appreciated area with a satisfaction rate of 58.9%. the lowest satisfaction rates, among the items studied at the Kairouan University Hospital in 2018 were: «the places of visits¼ (9%), «the quality of the catering¼ (20%), « tranquillity" (23%), and "attentiveness of staff to patient needs" (23%). CONCLUSION: At Ibn Al Jazzar University hospital of Kairouan, patient satisfaction was low regarding the quality of the services provided, particularly for areas related to the conditions of stay and the globality of care. Intervention measures based on these shortcomings should be undertaken.

Place of distancing measures in containing epidemics: a scoping review.

Distancing is one of the barrier measures in mitigating epidemics. We aimed to investigate the typology, effectiveness, and side effects of distancing rules during epidemics. Electronic searches were conducted on MEDLINE, PubMed in April 2020, using Mesh-Terms representing various forms of distancing ('social isolation', 'social distancing', 'quarantine') combining with 'epidemics'. PRISMA-ScR statement was consulted to report this review. A total of 314 titles were identified and 93 were finally included. 2009 influenza A and SARS-CoV-2 epidemics were the most studied. Distancing measures were mostly classified as case-based and community-based interventions. The combination of distancing rules, like school closure, home working, isolation and quarantine, has proven to be effective in reducing R0 and flattening the epidemic curve, also when initiated early at a high rate and combined with other non-pharmaceutical interventions. Epidemiological and modeling studies showed that Isolation and quarantine in the 2009 Influenza pandemic were effective measures to decrease attack rate also with high level of compliance but there was an increased risk of household transmission. lockdown was also effective to reduce R0 from 2.6 to 0.6 and to increase doubling time from 2 to 4 days in the covid-19 pandemic. The evidence for school closure and workplace distancing was moderate as single intervention. Psychological disorder, unhealthy behaviors, disruption of economic activities, social discrimination, and stigmatization were the main side effects of distancing measures. Earlier implementation of combined distancing measures leads to greater effectiveness in containing outbreaks. Their indication must be relevant and based on evidence to avoid adverse effects on the community. These results would help decision-makers to develop response plans based on the required experience and strengthen the capacity of countries to fight against future epidemics. Mesh words: Physical Distancing, Quarantine, Epidemics, Public Health, Scoping Review.

Editorial quality of the doctoral thesis at the Faculty of Medicine of Sousse (Tunisia).

OBJECTIVE: To assess the writing quality of the theses defended at the Faculty of Medicine of Sousse (FMSo). METHODS: This is a bibliometric, transversal and exhaustive study done on all theses defended at the FMSo between 2001 and 2005. The writing quality of the thesis was assessed, via double reading, by a grid applied to its abstract. This grid was composed of 20 items detailing the principles of scientific writing. A thesis was considered "satisfactory" when the writing score was ≥15 / 20. RESULTS: During this five-year period, 670 theses was defended at the FMSo (an average of 134 theses per year), which in 93% of cases were research ones. All these theses were written in French except for one. On a 20-point scale, the average thesis editorial score was 14.1 ± 2.2. The writing quality was judged satisfactory in 47% of the theses. The objective of the thesis, research design and study population were mentioned, respectively, in 81%, 77% and 91% of theses abstracts. However, the descriptors chosen were MeSH words in only 42% of the time; Data sources and standard deviation were mentioned in only 25% and 9.6% of the abstracts, respectively. CONCLUSION: The writing quality of the thesis at the FMSo suffered mainly from documentary, methodological and statistical insufficiencies. The introduction of a scientific medical writing module in the curriculum of the FMSo would be essential for the optimization of the medical thesis.

Perception of Tunisian Public Health Practitioners on the Role of Primary Health Care during the COVID-19 Pandemic.

CONTEXT: Primary Health Care is the first level of healthcare delivery services. Its role in the management of epidemics has been documented especially during the SARS and Ebola epidemics, and more recently during the COVID-19 pandemic. OBJECTIVE: To describe public health experts' perceptions of the implication of Primary Health Care on managing the COVID-19 pandemic in Tunisia. METHODS: This qualitative study was based on a structured interview covering five domains: 1. Preparedness, 2. Implication, 3. Health delivery, 4. Response and 5. Fight against COVID-19 in Primary Health Care in Tunisia. Convenient sampling was done to include public health practitioners and experts. RESULTS: A total of 25 experts were included with a sex ratio that was equal to 0.92, including two international experts, and four that were working in the Ministry of Health. The majority of respondents affirmed that the Tunisian PHC was not prepared to fight against the COVID-19 pandemic. Concerning the response role of PHC against COVID-19, some experts stated that PHC played an important role in the early stages of the pandemic. Almost all included participants claimed that PHC was marginalized from the national strategy against COVID-19. In addition, all respondents affirmed that there had been a weakening effect of the delivery of the minimum healthcare package that was dispended by the PHC after the pandemic. However, they all expressed the ability of PHC to manage future epidemics. CONCLUSION: The Tunisian PHC system did not play an efficient role in the current COVID-19 pandemic. However future lessons should be deduced for further implications in potential upcoming epidemics.

Forty-year Tunisian bibliometrics of general surgery theses in the four national faculties of medicine (1980-2019).

The objective of this work was to establish the bibliometric profile of Tunisian theses in 'general surgery' and to describe their themes, their study designs, and their writing quality. This is a retrospective descriptive bibliometric study, covering all the theses in medicine in the specialty of 'general surgery', defended in the four medical faculties of Tunisia, during the forty last years from 1980 to 2019. During the study period, 739 theses in 'general surgery' were discussed in Tunisia, with an average of 19 theses per year. The most studied research topic was emergencies (41%), followed by common surgical pathologies (26%) and digestive oncology (21.5%). Descriptive studies and case studies represented the majority of study designs with respective proportions of 56.9% and 40.6%. Only 20.7% of these theses had a scientific writing quality deemed satisfactory. The least respected elements in writing their summaries were statistical (confidence intervals and standard deviations) and documentary (keywords). Despite the plethora of themes of Tunisian theses in 'general surgery', their basic methodology and their editorial non conformity require the educational reform of the dissertations, both doctoral students and supervisors, by strengthening their skills in research methodology and scientific communication written.

Tuberculosis epidemiological trend in Sousse, Tunisia during twenty years (2000-2019).

Describe the epidemiology of tuberculosis in the last two decades (2000-2019) in the East region of Tunisia (city of Sousse). This was a descriptive retrospective analysis of notified incident cases of tuberculosis from 2000 to 2019 in Sousse Governorate, Tunisia. The data collection was done via the regional registry of tuberculosis. Stata software was used to characterize the socio-demographic and clinical profile of tuberculosis, to calculate its incidence, mortality and fatality rates and to determine predictive factors of mortality. R software was used to analyze the chronological trend of tuberculosis incidence and mortality. A total of 2606 incident cases of tuberculosis were declared from 2000 to 2019 in Sousse. The mean age was 39 ± 19 years with a sex ratio (male/female) of 1.19. Only one case was HIV positive among the total 2606 incident cases. Extra-pulmonary tuberculosis was the most recorded (1,534 cases, 58.9%). The mean annual case notification and deaths were 130 and four respectively. After adjusting for confounders, individuals with pulmonary tuberculosis were 1.9 significantly more likely to die from tuberculosis compared to those suffering from extra-pulmonary tuberculosis. There was a trend of increasing mortality with increasing age. The association was statistically significant only for those above 60 years' old who had 12.5 times higher odds of dying compared to those below 60 years. After adjusting for age and gender, with every year there was an increase in the total incidence rate (+0.35 per 100,000) with p = 0.005 and in the extra-pulmonary incidence (+0.27 per 100,000), with p = 0.001. This study demonstrated the increasing trend of tuberculosis in Sousse, Tunisia from 2000 to 2019. The national program against tuberculosis should enhance community knowledge and centralize the national and regional epidemiological information for better epidemiological surveillance.

Family Medicine (General Medicine): What academic and professional specificities?

Family Medicine, a true scientific and academic discipline, has been defined by the World Organization of National Colleges, Academies and academic associations of general practitioners / family physicians (WONCA) since 2002, as being a "clinical specialty oriented towards primary care". This paper details the specificities of Family Medicine: a horizontal specialty, primary care, providing comprehensive and continuous care, patient-centered and community-oriented. The promotion of Family Medicine in the Maghreb countries requires a multi-axial strategy based on the social marketing of Family Medicine, the recognition of Family Medicine as a medical specialty and of Family Medicine as a gateway to national health system, the establishment of a quality approach in basic health centers and free practice offices (centers of health centers) and regular validation of the Family Medicine diploma.

Morbidity diagnosed in an internal medicine department of a secondary care center (Msaken, Sousse, Tunisia).

INTRODUCTION: Internal Medicine is an essential component of the clinical platform of regional hospitals (relay between district hospitals and reference university hospitals). OBJECTIVE: To describe the morbidity diagnosed at Medicine department of the regional hospital of Msaken (Sousse, Tunisia), taken as a tracer of intermediate hospitals. METHODS: This descriptive study covered all of the patients hospitalized, during the year 2015, in the Internal Medicine department of the Msaken regional hospital. The data were disseminated through a "Minimum Clinical Summary". Morbidity was classified according to ICD-10. Hospital readmission was tested with reference to <28 days. RESULTS: A total of 594 patients were hospitalized in Internal Medicine, with a sex ratio of 0.95 and a median age of 67 years [54-78]. "Diseases of the respiratory system" were the first category of diagnosed morbidity (58%), dominated by acute bronchitis, followed by "endocrine, nutritional and metabolic diseases" in women (including insulin-dependent diabetes) and category of infectious diseases in men (including erysipelas). The former patients of the service (49%) were twice as numerous among people ≥60 years old (57% vs 30% in those under 60 years). The readmission rate was 19% (29% for men versus 8% for women). The mean length of stay was 7 ± 5.7 days. The transfer rates and hospital mortality were 11.3% and 1.2%, respectively. CONCLUSION: The morbidity diagnosed at the Internal Medicine department of the Msaken regional hospital was dominated by the triad: acute bronchitis, diabetes mellitus and erysipelas, particularly in the elderly. Hence the need to strengthen the training of future family doctors in pulmonology, diabetology and infectious diseases.

Typology of morbidity diagnosed in a pediatric department of a secondary care center (Msaken, Sousse, Tunisia).

INTRODUCTION: Pediatric services are tracer services for the assessment of the integration and performance of the national health system. OBJECTIVES: Describe the typology of morbidity notified to the Pediatrics department of the Msaken regional hospital (Sousse, Tunisia) and the flow of its patients. METHODS: This is a descriptive and exhaustive study, covering all the patients hospitalized in the pediatric ward of Msaken, during the year 2015. The data were collected through medical files and medical registers. admission, based on the Minimum Clinical Summary (RCM) form. The notified diagnoses were coded according to the WHO ICD-10 classification. The main diagnosis was defined by the major pathology that led to the hospitalization. Early readmission was retained before 28 days. RESULTS: A total of 521 children were hospitalized, with a sex ratio of 1.04 and a mean age of 2 ± 3 years; 70% of the patients came from the administrative center of the governorate and 62% were infants (age

Towards new perspectives Support for Prevention to the National Health System in Tunisia.

"Prevention", a component of primary health care since Alma Ata's declaration (1978), has been a strategic axis of health policy in Tunisia for four decades. If the Tunisian Revolutionary Constitution (2014) declared in its Article 38 that "the State guarantees prevention", the regulatory texts, organizing preventive structures and its operational programs, have today become ill-suited with the global burden of disease and current scientific evidence. The analysis of current preventive practices in Tunisia, based on the "health continuum", the taxonomy of "preventive strategies" and the identification of "vulnerable populations", has shown the need to implement prevention activities. "Primordial" and "quaternary" (for the management of cardiovascular diseases and cancers), extension of the fields of health education and epidemiological surveillance, towards Therapeutic Education of Patients / Health Promotion, and health monitoring, and coverage of new groups at risk: adolescents and the elderly. Faced with the multitude of prevention structures and the fragmentation of health programs, the reform of the national preventive policy and its practices should be based on the principles of integration, relevance and efficiency, through the establishment of a National Health Protection Agency (NHPA). This ANP is called upon to launch new prevention support projects including integrated preventive medicine centers (providing periodic health examinations), hospital patient therapeutic education services and home care units. Such a reform, announcing the birth of a new generation of preventive basic health care activities in Tunisia, should be reinforced by a legal, organizational and educational basis.

Global university performance. Bibliometric analysis of the ARWU platform (2003-2020).

OBJECTIVES: Describe the 2020 report of the ARWU "Academic Ranking World Universities" classification and identify, accordingly, the roadmap of academic excellence, particularly in the countries of the Greater Maghreb. METHODS: This is an in-depth reading of the 2020 results of the ARWU bibliometric platform (launched in 2003) from top 1000 world-class universities. Six criteria were used in this ranking: 1. Alumni (10%): students who received Nobel / Fields prizes; 2. Award (15%): professors who have won the Nobel / Fields prizes; 3. HiCi (20%): Most cited scientists; 4. PUB (20%): number of publications 5. TOP (20%): proportion of publications in the most influential periodicals; 6. PCP (10%): Per Capita Performance. RESULTS: The 2020 ARWU ranking was characterized by the domination of the "Top 10" ranking by the United States, particularly the "Harvard University", the Asian boom of 55% of the "Top 1000" ranking (Chinese universities evolved from 16 in 2004 to 81 in 2020 in the "Top 500" list) and finally an African incubation of academic excellence, manifested by the selection of nine South African institutions (including the "University of Cape Town ", world rank between 201-300), and the re-entry for the first time of a Maghreb university in the" Top 1000 "list, Tunis El Manar (rank between 901-1000), with the following scores: N&S: 1 , 4; Pub: 26.1 and PCP: 10.3, for a total score of 37.8 points. CONCLUSION: This report proves once again, the promising academic perspectives of Asia and Africa in the inclusion of the "Top 1000" list of the ARWU ranking. The roadmap for academic excellence would thus be based on the triad of centering scientific publications, in prestigious journals and by national author networks.

Results of 25 years of Maghrebian scientific medical research in the Grand Maghreb. Bibliometric analysis of the Scimago platform (1996-2020).

OBJECTIVE: Describe the trend and the characteristics of the positioning of Maghreb medical production and its visibility, at the global, African and Arab level, following an in-depth reading of the Scimago platform, over a period of 25 years (1996-2020 ). METHODS: This is an in-depth reading, centered on the Maghreb, of the Maghreb medical production referenced on the Scimago platform, from 1996 to 2020. The bibliometric extracts were based on the number of published "documents" and the index H: number of articles (h) from a country having received at least h citations. The benchmarking of the productivity and medical visibility of the five Maghreb countries (Tunisia, Morocco, Algeria, Libya, Mauritania) was carried out at the global (237 countries), African (59 countries) and Arab (21 countries) level. RESULTS: Following the first African countries producing the most medical documents (South Africa, Egypt and Nigeria), the position of the Maghreb countries varied from 4 in Tunisia to 36 in Mauritania. In Arab countries, the position of medical production, dominated by Egypt and Saudi Arabia, was 12 and 18, successively in Algeria and Libya. The evolution of medical documents recorded a cross between Tunisia and Morocco in 2014, followed by a deceleration in Moroccan production. In the Maghreb, the h index varied from 154 in Tunisia to 29 in Mauritania. CONCLUSION: In addition to its weak position in the world, African and Arab rankings over the past 25 years, Maghreb medical research has been characterized by a major fluctuation. The "Alliance for Excellence" charter of the PRP2S Network, based on the promotion of university essays and electronic journals, constitutes an operational roadmap for the development of the production and visibility of research in the Maghreb.