Ischemic Stroke in Young Tunisian Adults.

INTRODUCTION: Ischemic Stroke in young adults is a real public health problem; it's a major cause of disability, alters quality of life and has a great socio-economic impact. AIM: determine risk factors and specify the etiology of arterial ischemic stroke in young Tunisian adults. METHODS: In this 5 years retrospective study (2015-2020), we included all young adults (18-50 years) admitted for arterial ischemic stroke (AIS). Risk factors were registered and analyzed. All patients were investigated using a standard protocol: biological tests, brain imaging, carotid ultrasound and cardiac assessment. Additional investigations were carried out at the discretion of the treating physician. The cause of ischemic stroke was classified according to the TOAST criteria. RESULTS: We collected 200 patients with AIS. The mean age was 41.37 years ± 6.99. Traditional vascular risk factors were observed in more than 1/4 patients. A definite cause of stroke was identified in 120 patients. Cardio-embolic causes were the most common among our patients (19%) followed by atherosclerosis of the large arteries (11.5%). Other determined etiologies were found in 27.5% of patients. The etiology remained unclear in 40% of cases: undetermined despite complete investigation in 17.5%, undetermined and incompletely investigated 14.5 % and more than one potential pathomechanisms in 8%. CONCLUSION: Through this study, we demonstrated the diversity of etiology of stroke in young Tunisian adults. Changes of lifestyle are responsible for the occurrence of the traditional risk factors at an early age. Rheumatic heart diseases remain a frequent cause of AIS in our area.

Exploring 24-Hour Movement Behaviors in Early Years: Findings From the SUNRISE Pilot Study in Tunisia.

PURPOSE: The International Study of Movement Behaviors in the Early Years (SUNRISE) was conducted in Tunisia to assess the proportion of preschoolers who met the World Health Organization guidelines for physical activity, sedentary behavior, and sleep. The study also evaluated the feasibility of the methods for the SUNRISE study. METHODS: Five kindergartens were recruited from urban and rural areas in Tunisia. Physical activity and sleep duration were assessed using a waist-worn ActiGraph. Screen time and sleep quality were assessed via an interview-administered parent questionnaire. The NIH Toolbox was used. RESULTS: A total of 112 preschoolers were assessed (50 boys, age = 4.1 [0.58]). Only 18% of children met all recommendations of the World Health Organization guidelines, while 53% met the sedentary screen time (in minutes per day), and 41% met physical activity recommendation (in minutes per day). Eighty-one percent of children met the sleep duration recommendation (in minutes per day). There was good compliance with the ActiGraph protocol. CONCLUSIONS: This pilot study provided important insights into the feasibility of the study and the movement behaviors of Tunisian preschool children. The results suggest there is a need to promote healthy levels of physical activity and sedentary screen time in children, which should be a priority in public health initiatives, including preschool curricula, in Tunisia.

A 3-min weighted vests re-warmups induce sprint performance enhancements at the start of the second half of a soccer match-play.

Purpose: This study aimed to investigate the effect of re-warm-up (RWUP) activities consisting of three sets of 15-m sprints with weighted vests on 20-m sprint performance after the break. Methods: Using a randomized, and counterbalanced cross-over design, twenty U15 elite soccer players performed four RWUP trials which consisted of 15-min of passive rest (control: CONT), 3 × 15-m sprint (RW0%), sprinting with a vest-loaded at 5% of body-mass (BM) (RW5%), sprinting with a 10% BM vest (RW10%). The 3-min RWUP protocols started 10-min after the commencement of the 15-min between-halves break and concluded 2-min before its end. During each testing session, the participant's RPE scores, and 20-m sprint performance were registered before the first half, and at the end of the break of the simulated match-play. Results: Significant time effects [F (1.72) = 54.37, d = 1.88, p < 0.001; F (1.72) = 9.07, d = 0.77, p = 0.003], and condition effects [F (3.72) = 11.81, d = 1.53, p < 0.001; F (3.72) = 7.36, d = 1.21, p = 0.003] were observed for RPE scores and 20-m sprint performance, respectively. Significant condition-by-time interactions were found for RPE scores (p < 0.003, d = 0.54), and 20-m sprint performance (p < 0.002, d = 0.70). Contrast analysis showed significantly higher RPE scores (p < 0.001, d = 1.55), and improved 20-m sprint performance (p = 0.0004, d = 1.19) in the RW10% condition compared to all other conditions. Conclusion: Sprinting for 3-min with a 10% body-mass vest resulted in the highest RPE scores and the most substantial enhancements in 20-m sprint performance. Young elite soccer players should incorporate 10% body-mass weighted vests in their re-warm-ups to boost post-break sprint performance.

Prognostic Value of Serum Cholinesterase Activity in Severe SARS-CoV-2-Infected Patients Requiring Intensive Care Unit Admission.

We evaluated the prognostic value of serum cholinesterase (SChE) levels in SARS-CoV-2-infected patients requiring intensive care unit (ICU) admission. This is a retrospective study of severe, critically ill, adult COVID-19 patients, all of whom had a confirmed SARS-CoV-2 infection and were admitted into the ICU of a university hospital. We included all patients admitted to our ICU and whose SChE levels were explored on ICU admission and during ICU stay. One hundred and thirty-seven patients were included. There were 100 male and 37 female patients. The mean of SChE activity on ICU admission was 5,656 ± 1,818 UI/L (range: 1926-11,192 IU/L). The SChE activity on ICU admission was significantly lower in nonsurvivors (P < 0.001). A significant association between the SChE activity on ICU admission and the need for invasive mechanical ventilation was found. We also found a significant correlation between the SChE activity and other biomarkers of sepsis (C-reactive protein, procalcitonin, and leukocytes) on ICU admission and during the ICU stay. A significant correlation among SChE nadir value activity recorded during ICU stay, the occurrence of nosocomial infection, and the outcome of studied patients was found. Our study shows that the low SChE activity value is associated with a severe outcome. It might be used as a biomarker to aid in prognostic risk stratification in SARS-CoV-2-infected patients. Further studies for external validation of our findings are needed on this subject.

Clinical characteristics and outcomes of critically ill COVID-19 patients in Sfax, Tunisia.

BACKGROUND: Africa, like the rest of the world, has been impacted by the coronavirus disease 2019 (COVID-19) pandemic. However, only a few studies covering this subject in Africa have been published. METHODS: We conducted a retrospective study of critically ill adult COVID-19 patients-all of whom had a confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection- admitted to the intensive care unit (ICU) of Habib Bourguiba University Hospital (Sfax, Tunisia). RESULTS: A total of 96 patients were admitted into our ICU for respiratory distress due to COVID-19 infection. Mean age was 62.4±12.8 years and median age was 64 years. Mean arterial oxygen tension (PaO2)/fractional inspired oxygen (FiO2) ratio was 105±60 and ≤300 in all cases but one. Oxygen support was required for all patients (100%) and invasive mechanical ventilation for 38 (40%). Prone positioning was applied in 67 patients (70%). Within the study period, 47 of the 96 patients died (49%). Multivariate analysis showed that the factors associated with poor outcome were the development of acute renal failure (odds ratio [OR], 6.7; 95% confidence interval [CI], 1.75-25.9), the use of mechanical ventilation (OR, 5.8; 95% CI, 1.54-22.0), and serum cholinesterase (SChE) activity lower than 5,000 UI/L (OR, 5.0; 95% CI, 1.34-19). CONCLUSIONS: In this retrospective cohort study of critically ill patients admitted to the ICU in Sfax, Tunisia, for acute respiratory failure following COVID-19 infection, the mortality rate was high. The development of acute renal failure, the use of mechanical ventilation, and SChE activity lower than 5,000 UI/L were associated with a poor outcome.

Ecological and Construct Validity of a New Technical Level Cuban Dance Field Test.

The study aimed to explore the sensitivity and specificity of a new methodological approach related to the musical rhythm for discriminating a competitive Cuban dancer's (CDCs) level. Thirty CDCs (Age 23.87 ± 1.76 years, body mass 60.33 ± 9.45 kg, stature 1.68 ± 0.07 m) were divided into three groups: beginner (BEG, n = 10), intermediate (INT, n = 10), and advanced (ADV, n = 10) according to their training experience/level. Each dancer was assessed while dancing at three different musical rhythms: fast (118 BPM), medium (96 BPM), and slow (82 BPM). The assessed variables were average heart rate (HRM), peak (HRP), and dancing time (DCT). The ADV group succeeded at all three musical combinations (317, 302, 309 s for 82, 96, 118 BPM). The INT group correctly performed only the first two combinations (304, 304 s for 82, 96 BPM), while a significant time difference was shown at the fast musical rhythm (198 ± 6.64 s) compared to the medium (p < 0.001) and slow rhythms (p < 0.001) respectively. As the speed of the musical rhythms increased, the BEG group was not able to follow the rhythm: their results were 300 ± 1.25 s for the slow musical rhythm, 94.90 ± 12.80 s for the medium musical rhythm and 34.10 ± 5.17 s for the fast musical rhythm (p < 0.001). The HRM and HRP grew along with the increase in musical rhythm for all groups (p < 0.001). The ROC analysis showed a high sensitivity and specificity in discriminating the groups for each rhythm's condition. The BEG and INT groups showed an AUC = 0.864 (95% CI = 0.864-0.954); INT and ADV showed an AUC = 0.864 (95% CI = 0.864-0.952); BEG and ADV showed an AUC = 0.998 (95% CI = 0.993-1.000). The results of this study provided evidence to support the construct and ecological validity of the time of the musical rhythms related to competitive CDCs. Furthermore, the differences in the performances according to various musical rhythms, fast (118 BPM), medium (96 BPM), and slow (82 BPM), succeeded in discriminating a dancer's level. Coaches and strength and conditioning professionals should include the Cuban Dance Field Test (CDFT) in their test battery when dealing with talent detection, selection, and development.

Impact of prone position on outcomes of COVID-19 patients with spontaneous breathing.

BACKGROUND: In this study, we explored whether early application of the prone position (PP) can improve severe hypoxemia and respiratory failure in coronavirus disease 2019 (COVID-19) patients with spontaneous breathing. METHODS: This is a prospective observational study of severe, critically ill adult COVID-19 patients admitted to the intensive care unit. All vital parameters were recorded in real time for all patients. Moreover, the results of chest computed tomography (CT), when available, were analyzed. RESULTS: PP was applied in 21 patients who were breathing spontaneously. The application of PP was associated with a significant increase in oxygen saturation measured by pulse oximetry (SpO2) from 82%±12% to 96%±3% (P<0.001) 1 hour later. Moreover, PP was associated with a significant reduction in respiratory rate from 31±10 to 21±4 breaths/min (P<0.001). Furthermore, the number of patients who exhibited signs of respiratory distress after PP was reduced from 10 (47%) to 3 (14%) (P=0.04). Early PP application also led to a clear improvement on CT imaging. It was not, however, associated with a reduction in mortality rate or in the use of invasive mechanical ventilation (P>0.05 for both). CONCLUSIONS: Our study confirmed that the early application of PP can improve hypoxemia and tachypnea in COVID-19 patients with spontaneous breathing. Randomized controlled trials are needed to confirm the beneficial effects of PP in COVID-19 patients with spontaneous breathing.

Dynamic Warm-Up With a Weighted Vest: Improvement of Repeated Change-of-Direction Performance in Young Male Soccer Players.

PURPOSE: To explore the effect of 4 different warm-up strategies using weighted vests and to determine the specific optimal recovery duration required to optimize the repeated change-of-direction (RCOD) performance in young soccer players. METHODS: A total of 19 male soccer players (age 18 [0.88] y, body mass 69.85 [7.68] kg, body height 1.75 [0.07] m, body mass index 22.87 [2.23] kg·m-2, and body fat percentage 12.53% [2.59%]) completed the following loaded warm-up protocols in a randomized, counterbalanced cross-over, within-participants order and on separate days: weighted vest with a loading of 5% (WUV5%), 10% (WUV10%), 15% (WUV15%) body mass, and an unloaded condition (control). RCOD performance (total time, peak time, and fatigue index) was collected during the preintervention phase (5 min after the dynamic stretching sequence) for baseline values and immediately (at 15 min), at 4- and 8-minute postwarm-up intervention. RESULTS: For each postwarm-up tested, recovery times (ie, 15 s, 4 min, and 8 min), of both total and peak times were faster following WUV5%, WUV10%, and WUV15%, compared with the unloaded condition (P ≤.001-.031, d = 1.28-2.31 [large]). There were no significant differences (P = .09-1.00, d = 0.03-0.72 [trivial-moderate]) in-between recovery times in both total and peak times following WUV5%, WUV10%, and WUV15%. However, baseline fatigue index score was significantly worse than all other scores (P ≤.001-.002, d = 1.35-2.46 [large]) following the loaded conditions. CONCLUSIONS: The findings demonstrated that a dynamic loaded warm-up increases an athlete's initial RCOD performance up to the 8-minute postwarm-up intervention. Therefore, strength coaches need to consider using weighted vests during the warm-up for trained athletes in order to acutely optimize RCODs.

Warm-Up With Dynamic Stretching: Positive Effects on Match-Measured Change of Direction Performance in Young Elite Volleyball Players.

PURPOSE: To explore the immediate (15-s post-warm-up) and the delayed (after 20 and 40 min of simulated volleyball play) effects of 2 different warm-up protocols-a stretching-free volleyball warm-up (NS) and a warm-up incorporating dynamic stretching (DS)-on subsequent change of direction (COD) performance in young elite volleyball players. METHODS: Sixteen male players (age 16.88 [0.34] y, body mass 75.81 [5.41] kg, body height 1.91 [0.05] m, body mass index 20.84 [1.79] kg·m-2, and body fat percentage 9.48 [1.83]%) from the U-17 national volleyball team performed NS and DS on 2 different nonconsecutive days. During each testing session (NS and DS), half T-test performance measurements were performed after 5 minutes of a general warm-up (ie, baseline), immediately post-warm-up (after 15 s), and after 20 and 40 minutes of simulated volleyball play. RESULTS: For DS, a significant improvement in COD performance (2.08%, P < .001) was observed after 20 minutes of play compared with the baseline values. In addition, COD performance recorded after 40 minutes of play was better than after 15-second post-warm-up (5.85%, P = .001). Inferential statistics showed better COD performance in the DS condition after 20 minutes of play (2.32%, likely negative, d = 0.61). CONCLUSIONS: Compared with NS, DS tended to affect the pattern of improvement of COD performance during play by intensifying and accelerating it. Consequently, to enhance COD performance for up to 40 minutes into the game, it is recommended that DS be incorporated to the warm-up preceding the match.

Pulmonary embolism in intensive care units: More frequent or more Known? Prospective study of 75 cases.

PURPOSE: to evaluate the current rate of pulmonary embolism (PE) in our medico-surgical intensive care unit (ICU), to identify risk factors, and to determine the outcome of PE in ICU. METHODS: We performed a prospective cohort study of consecutive patients requiring intensive care admission during a one-year period. We included, in this prospective study, all the patients with confirmed PE admitted in ICU with more than 18 years of age, and expected to stay in ICU for more than 48 hours. Only the patients who had a clinical suspicion (unexplained hypoxemia and/or shock) for PE underwent diagnostic studies. RESULTS: During the study period, 842 patients were admitted in our ICU. One hundred and two patients were excluded. The diagnosis of PE was confirmed in 75 patients (10.1%). In our study, all patients (100%) had received some forms of pharmaceutical prophylaxis (PP) during ICU stay. The median time from ICU admission to diagnosis of PE was 6 days. The diagnosis of PE was made by spiral CT in 74 patients (98.7%), and by echocardiography in 1 case (1.3%). The mean ICU stay was 26.3 ± 26.5 days (median: 20 days). During their ICU stay, 73 patients (97.3%) developed one, or more, organ failure. Respiratory failure was the most observed (97.3%). Moreover, 38 patients (50.6%) developed nosocomial infections and 29 (38.6%) died. The multivariate analysis showed that the risk factors associated with mortality were the presence of shock the day of PE diagnosis and the presence of right ventricular dilatation on echocardiography. CONCLUSION: Our findings confirm that subjects in the ICU are at high risk of PE, due to a high number of risk-factors. PE was associated with higher ICU mortality and a significantly higher ICU LOS. Our results invite to revise the preventive strategies of deep venous thrombosis and PE in patients requiring ICU admission.

Evidence of Direct Toxicological Effects of Scorpion Venom on Central Nervous System in Tunisian Children.

BACKGROUND: Severe scorpion envenomation can lead to severe neurological manifestations, which are an indicator of the severity of the scorpion sting. The direct action of scorpion venom on the central nervous system can explain partly these neurological disorders. METHODS AND FINDINGS: We report a case of severe scorpion envenomation in 16-month-old boy with no pathological history admitted in ICU for severe scorpion envenomation. The result of cerebral MRI agrees with the hypothesis of direct action of scorpion venom on the central nervous system. Patient had improved; however, he has kept as neurological sequelae language disorders and blindness. The boy was discharged 21 days after ICU admission. CONCLUSION: Our observation confirms that severe scorpion envenomation can be complicated by severe neurological manifestations. Although one case report is not enough to conclude such important hypothesis regarding the direct effect of scorpion venom on central nervous system (especially that the age of patient is more than one year), our case agrees with this hypothesis.

Incidence, mechanisms and impact outcome of hyperglycaemia in severe scorpion-envenomed patients.

Hyperglycaemia is often observed in severe scorpion-envenomed patients. It is due to a severe autonomic storm with a massive release of catecholamines, increased glucagon levels, cortisol levels, and either decreased insulin levels or insulin resistance. The presence of hyperglycaemia is an indicator of severity in this specific condition. Indeed, hyperglycaemia was associated with the severity of clinical manifestations of severe scorpion envenomation requiring intensive care unit (ICU) admission. In fact, the presence of hyperglycaemia was associated with the presence of respiratory failure, pulmonary oedema, haemodynamic instability, neurological failure, multisystem organ failure, and an increased mortality and ICU length of stay. As a consequence, we think the presence of hyperglycaemia in scorpion-envenomed patients at the emergency department prompts searching for presence of systemic manifestations or cardiorespiratory manifestations. As a consequence, the presence of hyperglycaemia can help screen severe patients at the emergency department. The current management of severe scorpion envenomation involves the admission and close surveillance in the ICU, where vital signs and continuous monitoring enable early initiation of therapy for life-threatening complications. The use of antivenom for scorpion stings remains controversial. All patients with pulmonary oedema should receive prazosin and possibly dobutamine, according the scorpion's species. Mechanical ventilation is usually used in severe cases. Insulin should be reserved for severe cases with confirmed excessive hyperglycaemia (>10 mmol/l).

Value of Serum Cholinesterase Activity in the Diagnosis of Septic Shock Due to Bacterial Infections.

BACKGROUND: We aimed to investigate whether serum cholinesterase (SChE) activity can be helpful for the diagnosis of septic shock and to evaluate its usefulness in comparison with procalcitonin (PCT) and C-reactive protein (CRP). METHODS: A prospective single-blinded study conducted in an intensive care unit of university hospital. Patients were classified as having cardiogenic shock, septic shock, or hemorrhagic shock. We also included a control group without neither hemodynamic instability nor sepsis. For all included patients, SChE, PCT, and CRP were simultaneously sampled. RESULTS: The comparison of sepsis markers between all groups showed that the mean values of PCT and CRP were significantly higher in patients with septic shock. However, SChE activity was significantly lower in this group. The SChE activity was found to be more accurate than PCT and CRP for the diagnosis of septic shock. In fact, an SChE activity ≤ 4000 UI/L predicted the diagnosis of septic shock with a sensitivity of 78%, a specificity of 89%, a predictive negative value of 97%, and a predictive positive value of 65%. However, the prognostic value of SChE activity was poor in multivariate analysis. CONCLUSION: The SChE activity level was significantly decreased in patients with septic shock. However, its prognostic value is poor. Our results suggest that SChE activity is useful for the diagnosis of septic shock. Further studies are warranted to confirm our findings.