What constitutes an obstructive ventilatory impairment in a pediatric population? A study design.

INTRODUCTION: There is no clear consensus as to what constitutes an obstructive ventilatory impairment (OVI) in pediatric populations. AIM: To determine the percentage of children/adolescents having an OVI among those addressed for spirometry after taking into account the definitions advanced by some international scholarly societies [British Columbia (BC), British thoracic-society (BTS), Canadian thoracic society (CTS), European respiratory society and American thoracic society (ERS-ATS), global initiative for asthma (GINA), Irish college of general practitioners (ICGP), national asthma council (NAC), national institute of clinical excellence (NICE), Société de pneumologie de langue française, Société pédiatrique de pneumologie et allergologie (SPLF-SP2A), and South African thoracic society (SATS)]. METHODS: This bi-centric cross-sectional study involves two medical structures in Sousse/Tunisia, and will encompass children/adolescents aged 6-18 years. A medical questionnaire will be administered, clinical and anthropometric data will be collected, and the spirometric data will be measured by two spirometers. The following six definitions of OVI will be applied: i) GINA: Forced expiratory volume in 1 second (FEV1) < 80% and a FEV1/forced vital capacity (FVC) ≤ 0.90; ii) ICGP: FEV1/FVC < 0.70; iii) ERS-ATS or BTS or SATS or SPLF-SP2A or NAC: FEV1/FVC z-score < -1.645; iv) NICE: FEV1/FVC < 0.70 or FEV1/FVC z-score < -1.645; v) CTS: FEV1/FVC < 0.80 or a FEV1/FVC z-score < -1.645; and vi) ERS: "FEV1 z-score or FEV1/FVC z-score" < -1.645 or "FEV1 or FEV1/FVC" < 0.80. EXPECTED RESULTS: The percentage of children/adolescents having an OVI will significantly vary between the six definitions. CONCLUSION: The frequency of OVI in a pediatric population will depend on the definition chosen.

Lighting the way: Exploring diurnal physical performance differences in school-aged visually impaired children and adolescents.

Circadian rhythms play a pivotal role in governing various physiological processes, including physical performance. However, in individuals deprived of light perception, such as the blind, these circadian rhythms face disruption. This study aimed to explore the influence of disturbed circadian rhythms on short-term maximal physical performance in children and adolescents with visual impairment. Forty-five volunteers participated in this study, comprising 17 blind, 13 visually impaired, and 15 sighted participants. The participants underwent a series of tests assessing maximal isometric strength performance across two days. To mitigate the influence of morning session fatigue on the evening results, each participant group performed in two separate testing sessions (i.e. in the morning (7:00 h) and in the evening (17:00 h)) on non-consecutive days in a randomized and counterbalanced setting, with approximately 36 h of recovery time between sessions. To mitigate the impact of inter-individual differences on mean values and to account for the influence of age and sex on the studied variables, data were normalized. The outcomes revealed a significant diurnal variation in maximal isometric strength performance among sighted individuals, with peak performance observed in the evening. This pattern aligns with their well-entrained circadian rhythm. In contrast, blind and visually impaired individuals did not display significant diurnal variation, signaling disrupted circadian rhythms due to the absence of light perception. These findings emphasize the crucial consideration of circadian rhythms in assessments of physical performance, especially among participants with visual impairments.

Designing a study on footballers' injuries in the 2024 African cup of nations competition (Ivory Coast).

INTRODUCTION: To enhance players' performance and implement effective injury prevention protocols and surveillance programs in football, it is essential to conduct epidemiological studies. Since significant disparities in injury rates across various football competitions were reported, it is important to characterize injuries in the context of the African cup of nation (AFCON) competition. AIM: To determine the incidence and factors associated with injuries among African footballers during the 2024 AFCON competition, which will be held in Ivory Coast from January 13 to February 11, 2024. METHODS: Two expert physician in sports medicine will perform an analytical study (i.e.; a video-based analysis) of the 52 matches that will be played during the 2024 AFCON. The following parameters will be noted: i) Injury incidence, ii) Characteristics of injured players such as age, on-field position, and player league continent, iii) Characteristics ofinjuries such as mechanism, body location, moment of injury in terms of the minute of play and the round of the match, place of the injury in term of stadium zone, replacement consequent to the injury, absence next match, re-injury, recurrence of the injury with the same location during the competition, referee decision, and stoppage time for on-field injury, and iv) Characteristics of matches such as the match' schedule, ambient temperature, humidity, and wind speed. CONCLUSION: This study will allow enriching the existing literature with additional data regarding the injuries and the players' characteristics in the African context.

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.

The effects of high-intensity interval training and Iranian propolis extract on serum levels of TRPV4 and CYP2E1 proteins in patients with nonalcoholic fatty liver.

INTRODUCTION: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver failure, fibrosis, cirrhosis, and liver cancer, which can eventually lead to death. AIM: To investigate the effects of high-intensity interval training (HIIT) and iranian propolis extract on serum levels of transient receptor potential cation channel subfamily V member 4 (TRPV4) and cytochrome P450 2E1 (CYP2E1) proteins in patients with NAFLD. METHODS: Thirty-two patients with NAFLD (mean±standard deviation of age: 45.1±3.6 years; body mass index: 30.0±3.6 kg/m2) were assigned in a randomized control trial to one of the following groups: HIIT (n=8), propolis supplement (n=8), propolis + HIIT (n=8), and controls (n=8). The subjects participated in eight weeks of HIIT (one bout of 1-min intervals at 80-95% of the maximal heart-rate, interspersed by two min at 50-55% of the reserve heart-rate). The Propolis supplement was taken three times a day by the patients in the form of 50 mg tablet after the main meals. Body composition, liver injury test (eg; Alanine- and Aspartate- aminotransferase levels), liver ultrasound and serum levels of TRPV4 and CYP2E1 were measured before and after intervention. One-way analysis of variance was used to compare post-tests among the groups. RESULTS: HIIT significantly reduced serum levels of TRPV4 protein (p=0.001). The reduction in CYP2E1 was not significant in HIIT group (p=0.075). Propolis consumption had no significant effect on serum levels of CYP2E1 protein (p=0.059), and TRPV4 (p=0.072). There was a significant decrease in TRPV4 and CYP2E1 in the HIIT (p=0.001) and propolis supplement (p=0.032) groups. CONCLUSION: HIIT and propolis supplementation can be used to reduce TRPV4 and CYP2E1, which in turn reduces oxidative stress and inflammation in patients with NAFLD.

Postoperative multimodal rehabilitation for spontaneous smile restoration in severe Moebius syndrome: A case report and a short literature review.

Moebius syndrome (MS) is a rare congenital disorder characterized by bilateral facial paralysis, significantly impacting an individual's ability to convey emotions. The lengthening temporalis myoplasty (LTM) surgery is a crucial palliative intervention that can restore the smile in patients with MS by transferring the functional temporalis muscle to the paralyzed facial commissure. However, successful outcomes are closely tied to postoperative functional rehabilitation. This case report details the experience of a 29-year-old woman with severe MS who underwent LTM surgery followed by a comprehensive rehabilitation program. Over a period of 12 months, the patient achieved a spontaneous and symmetrical smile through a three-stage rehabilitation program focused on mandibular, voluntary, and spontaneous smile recovery. Speech therapy and psychological support were also integral components. This case underscores the importance of adopting a holistic approach to ensure successful and enduring outcomes from smile restoration surgery in patients with MS.

Short-term effects of announcing spirometric lung-age on smokers' attitudes: results from a Tunisian real-life pilot study.

BACKGROUND: To determine the effects of informing smokers of their spirometric lung-age (SLA) on smoking cessation (SC) rates and tobacco consumption. RESEARCH DESIGN AND METHODS: An interventional study was conducted in real-life through a humanitarian event led by the Red Crescent on 9 January 2022, in Hammam-Sousse (Sousse, Tunisia). The study comprised four steps: i) Medical questionnaire (general questionnaire, Fagerström test for cigarette dependence, SC motivation questionnaire); ii) Measurement of spirometric data; iii) SLA estimation and its announcement to participants; and iv) Self-reported evaluation of smoking behavior three months later through telephonic recall. Smokers were divided into groups (nondependent vs. dependent groups and insufficient/moderate motivation vs. high/very high motivation groups) and categories (ceased smoking, reduced consumption, maintained stable or increased consumption). RESULTS: Fifty-two smokers were included (94% were males). Three months after the event, i) 9 (17%) smokers ceased smoking, ii) 39 (75%) smokers reduced their daily smoking consumption by 12 ± 8 cigarettes/day, and iii) 4 (8%) smokers maintained stable (n = 3) or increased (n = 1) consumption. CONCLUSIONS: Informing smokers of their SLA led 92% of them to cease smoking or reduce their consumption. Announcing SLA could be an effective motivational tool and an easy-to-understand concept to help smokers cease their habit.

Enhancing scholarly discourse in the age of artificial intelligence: A guided approach to effective peer review process.

The integrity of the peer-review process (PRP) is paramount in academic publishing and serves as a critical filter for scholarly output. This mini-review centers on the introduction of comprehensive guidelines, presented in tables format, aimed at streamlining the interactions between authors and reviewers during the PRP. These guidelines, derived from an in-depth exploration of the PRP, offer structured and practical advice to ensure constructive, transparent, and effective communication, especially related to the use of artificial intelligence. While this mini-review discusses the strengths and challenges of the current PRP, its primary focus is on providing tangible recommendations to enhance the quality and efficiency of the PRP. By providing explicit guidelines and emphasizing the cooperative essence of peer review, this mini-review aims to improve the PRP, ensuring that it remains a robust mechanism for upholding the highest standards of research and knowledge dissemination in an evolving academic setting.

How to interpret parameters of routine lung function tests in 2023?

The diagnosis and management of the most prevalent chronic respiratory diseases partially rely on parameters obtained from pulmonary functional tests (PFTs), including spirometry, plethysmography, and carbon monoxide diffusion capacity (DLCO) measurement. In practice, the interpretation of PFTs' parameters is based on international recommendations issued by renowned scientific societies such as the American Thoracic Society (ATS) and the European Respiratory Society (ERS). The interpretation standards for PFTs established by ATS/ERS in 2005 were updated in 2022. According to the ATS/ERS-2022 standards, the interpretation of PFTs can be summarized in five steps. The first step involves comparing the determined parameters with those observed in a reference population of healthy individuals. This step helps determine whether the determined parameters are low, normal, or elevated. The second step aims to identify potential ventilatory impairments, such as obstructive and/or restrictive ventilatory impairments, which can be observed in certain chronic respiratory or extrarespiratory diseases. The third step involves assessing the severity of the identified ventilatory impairment or the decrease in DLCO. The fourth step entails evaluating the response to bronchodilator testing, if performed. Finally, if previous PFTs results are available, it is important to identify significant changes in certain PFTs parameters over time by comparing current and previous results. This clinical practice guide provides a comprehensive synthesis of the different steps in PFTs interpretation, taking into account the recommendations from ATS/ERS-2022.

Workload management strategies in football: A global survey project.

AIM: This research design protocol outlines the methodology for a thorough evaluation of workload monitoring and management strategies in football. METHODS: The study involves conducting a global survey to fitness coaches, sports scientists, analysts, and physicians with experience in load monitoring within football. The research adheres to the principles of the Helsinki Declaration and complies with General Data Protection Regulation standards, with ethical approvals obtained from multiple Ethics Committees across various countries, including Tunisia. A consortium of professionals collaboratively crafted the survey instrument, dividing it into seven sections, each addressing specific aspects of workload monitoring in football. Survey reliability will undergo evaluation in a pilot study utilizing Cronbach's alpha and intraclass correlation coefficient. To ensure inclusivity, the survey will be translated into multiple languages, facilitating participation from diverse regions. As such, survey distribution will consider online platforms (such as social media) and email invitations, with a specific focus on engaging football clubs, federations, and professional networks. The targeted sample size will remain at 385 participants. Statistical analysis planning encompasses descriptive examination, exploration of variable relationships, hypothesis testing, and qualitative analyses of participant feedback and recommendations regarding load monitoring practices. EXPECTED RESULTS: Expected outcomes include i) A comprehensive global overview of training and match load monitoring practices in football, ii) The identification of emerging trends, an improved understanding of training optimization processes, and iii) The development of practical recommendations to enhance player well-being and performance. CONCLUSION: This study will contribute to the ongoing development of knowledge in the field of football workload monitoring.

ChatGPT is not ready yet for use in providing mental health assessment and interventions.

Background: Psychiatry is a specialized field of medicine that focuses on the diagnosis, treatment, and prevention of mental health disorders. With advancements in technology and the rise of artificial intelligence (AI), there has been a growing interest in exploring the potential of AI language models systems, such as Chat Generative Pre-training Transformer (ChatGPT), to assist in the field of psychiatry. Objective: Our study aimed to evaluates the effectiveness, reliability and safeness of ChatGPT in assisting patients with mental health problems, and to assess its potential as a collaborative tool for mental health professionals through a simulated interaction with three distinct imaginary patients. Methods: Three imaginary patient scenarios (cases A, B, and C) were created, representing different mental health problems. All three patients present with, and seek to eliminate, the same chief complaint (i.e., difficulty falling asleep and waking up frequently during the night in the last 2°weeks). ChatGPT was engaged as a virtual psychiatric assistant to provide responses and treatment recommendations. Results: In case A, the recommendations were relatively appropriate (albeit non-specific), and could potentially be beneficial for both users and clinicians. However, as complexity of clinical cases increased (cases B and C), the information and recommendations generated by ChatGPT became inappropriate, even dangerous; and the limitations of the program became more glaring. The main strengths of ChatGPT lie in its ability to provide quick responses to user queries and to simulate empathy. One notable limitation is ChatGPT inability to interact with users to collect further information relevant to the diagnosis and management of a patient's clinical condition. Another serious limitation is ChatGPT inability to use critical thinking and clinical judgment to drive patient's management. Conclusion: As for July 2023, ChatGPT failed to give the simple medical advice given certain clinical scenarios. This supports that the quality of ChatGPT-generated content is still far from being a guide for users and professionals to provide accurate mental health information. It remains, therefore, premature to conclude on the usefulness and safety of ChatGPT in mental health practice.