Impact of the COVID-19 Pandemic on Orthopedic and Trauma Departments in Tunisia.

OBJECTIVE: Measure the effect of the strategy to fight the Covid-19 pandemic, based on containment, on the practice of orthopedic and trauma surgery in Tunisia. METHODS: This is a comparative study, concerning the impact of Covid-19 on the flow of patients, operated in orthopedic surgery and trauma departments, during the containment period from March 12, 2020 to April 30, 2020, comparing it to the same period of the year 2019, in the Central-East region of Tunisia (Kairouan, Sousse, Mahdia, Monastir). RESULTS: A significant decrease of 27% in the flow of patients admitted to orthopedic surgery departments in central-eastern Tunisia, during the 2020 containment period, compared to the same period of the previous year was documented. This decrease was generally widespread, notified in three orthopedic departments: Sousse (39%; p<10-3), Monastir (29%; p<10-3) and Mahdia (27%; p<10-3). It focused on the following three groups: infections (45%; p<10-3), wounds (30%; p<10-2), and fractures (20%; p<10-3). CONCLUSION: The collateral effects of the strategy to fight the Covid-19 pandemic, are "obvious" in orthopedic surgical practice. A health crisis management plan (including disasters and pandemics) should be better prepared in orthopedic surgery departments.

Cervical spine tuberculosis.

Tuberculosis of the cervical spine differs from other vertebral localizations by its extreme rarity, the clinical images are very diversified, the radiological measurements allow a good diagnostic orientation and specifically the MRI which allows a multi-planar study of the various lesions. Only bacteriological evidence can confirm the diagnosis. The treatment is based on a 12-month antituberculosis multidrug therapy and much debate upon the surgical indication. In our case, the patient presented with bilateral cervicobrachialgia with pain on examination at the mobilization of the cervical spine. A standard X-ray, a cervical CT scan, and a cervical MRI were performed, showing a C4 vertebral body compression of a probably infectious origin. The biopsy confirmed the diagnosis of a Cervical Pott's Disease that had been treated with anterior arthrodesis and TB treatment with rehabilitation, the patients' neurological symptoms improved, and he was doing well.

Intramuscular cavernous haemangioma of the triceps.

A 16-year-old teenager presented himself with a swollen left elbow, with no associated vascular-nerve complications. The standard radiography was without abnormalities. The echography showed the presence of an oblong vascularized formation occupying the posterior part of the elbow. The magnetic resonance imaging (MRI) showed a hyper vascularized lesion developing at the expense of the brachial triceps muscle with an intermediate signal intensity on the sequences weighted in T1 and a hyper signal in T2. The anatomopathological study of the initial biopsy and of the tumor part concluded with a cavernous hemangioma. Although their origin is vascular, hemangiomas never metastasize and do not undergo malignant transformation. The treatment of symptomatic hemangioma consists of surgical excision.

Acute hematogenous osteomyelitis of the talus: a case report.

In children, osteomyelitis is common in the long bones of the femur and the tibia. However, talar osteomyelitis is extremely rare. The condition is difficult to diagnose due to the slow onset and atypical pattern of the symptom. We report the case of a 9-month-old male, coming from a rural area, with talar osteomyelitis. The patient's history of a trauma that resembled an ankle contusion had delayed the diagnosis and subsequently developed into septic arthritis. He was treated by curettage, immobilization in plaster and appropriate antibiotics with full recovery of function in his right ankle and foot three months after the first outpatient visit. The bony cavity was healed six months after the operation and there were no growth disturbances or any abnormalities of the adjacent joints. This case report aims to present the difficulties in the diagnosis and therapeutic approach of this disease.

Tuberculosis cost in tunisia.

BACKGROUND: Tuberculosis (TB) infects one third of the world population. Its economic impact is important, affecting the global economy in the World. OBJECTIVE: To determine the economic costs related to tuberculosis in Tunisia. METHODS: Calculations were made for the reference year 2013; we covered all cost components of the disease, which are related to program management, BCG vaccination, health workers training, social mobilization, screening, chemoprophylaxis, and tuberculosis care. With the exception of costs related to care, which were the subject of a specific survey, the costs of other categories were obtained from the National TB Control Program. RESULTS: The cost of the different components related to the management, prevention, screening and tuberculosis care in 2013 amounted 504688,000DT. The cost of care represented 80.0% of total costs (6807 808,000DT) ; cost related to program  management represented 13.2% (1 121 580,00 DT) and the BCG vaccination  6.0% e (512 300,00DT) The average cost per patient was 1447,360 DTin 2013. CONCLUSION: Reducing the cost of tuberculosis, would involve reducing diagnostic delay. It is also recommended to reduce hospitalization recourse, and prevent multidrug resistance which lead to additional expenditures.

Tuberculosis cost in tunisia.

BACKGROUND: Tuberculosis (TB) infects one third of the world population. Its economic impact is important, affecting the global economy in the World. OBJECTIVE: To determine the economic costs related to tuberculosis in Tunisia. METHODS: Calculations were made for the reference year 2013; we covered all cost components of the disease, which are related to program management, BCG vaccination, health workers training, social mobilization, screening, chemoprophylaxis, and tuberculosis care. With the exception of costs related to care, which were the subject of a specific survey, the costs of other categories were obtained from the National TB Control Program. RESULTS: The cost of the different components related to the management, prevention, screening and tuberculosis care in 2013 amounted 504688,000DT. The cost of care represented 80.0% of total costs (6807 808,000DT) ; cost related to program  management represented 13.2% (1 121 580,00 DT) and the BCG vaccination  6.0% e (512 300,00DT) The average cost per patient was 1447,360 DTin 2013. CONCLUSION: Reducing the cost of tuberculosis, would involve reducing diagnostic delay. It is also recommended to reduce hospitalization recourse, and prevent multidrug resistance which lead to additional expenditures.

[Severe community acquired pneumonia due to Staphylococcus aureus in children. About two cases]. / Pneumonies staphylococciques graves de l'enfant. A propos de deux observations.

The staphylococcal pneumonia is the prerogative of the infant but rare cases were observed in the childhood. We report the observation of two children aged respectively of six years and three years and a half having presented a particular form of severe staphylococcal pneumonia apart from any context of immunodepression. The identification of the particular strains producing toxins Like the Panton and Valentine leukocidin constitutes the first stage of the comprehension of this atypical form of pneumonia. Through these observations and with a review of literature we underline the specific clinical and biological aspects of this form.