Assessment of the quality of the change of surgical wound dressings by the nursing staff in a university hospital of Tunis.

BACKGROUND: Infection of surgical wounds is the main cause of nosocomial infections. In the event of a defect in the care chain, in particular, during the change of the postoperative dressings, the infectious risk would be increased. AIM: To evaluate the gestures of change of dressing practiced by nurses of a university hospital department of surgery, in order to observe the insufficiencies. METHODS: We conducted a two-month-duration prospective, descriptive study having a qualitative approach, consisting of a protocol for observing nursing procedures carried out during the implementation of postoperative dressings in a university hospital surgery department from Tunis. A five-item observation grid was developed based on the nursing procedures that should be performed during dressing rehabilitation. RESULTS: This observation was made on 48 changes of dressings made by 13 nurses (eight women and five men). Inadequacies were noted during the preparation of the gesture, the preparation of the equipment, the execution of the act, the storage of the equipment and the transmission of the care to the rest of the nursing staff. CONCLUSION: The results of our study are consistent with a deficiency of the quality of repair of wounds by the nurses. They show a poor application of the rules of asepsis when repairing surgical wounds. This would be only partly due to inadequate staff training, as the majority of participating nurses were found to be familiar with the basics of the means and methods used to prevent infection of a wound. Other causes are lack of staff and work overload, lack of adequate material for the given care as well as lack of self-responsibility for its nursing practice. The resolution of these problems requires the setting up of an epidemiological surveillance system and the in-service training of the staff involved.

Encapsulating sclerosing peritonitis : two rare observations and literature review.

Sclerosing encapsulating peritonitis (SEP) is a rare and little known pathological entity. It is a chronic fibro-inflammatory disease of the peritoneum, resulting in the formation of a thick fibrous membrane, which engages partially or totally the abdominal organs. Clinical and radiological signs make the diagnosis difficult to establish preoperatively. We present two original observations of SEP illustrating different clinical presentations, diagnostic and therapeutic means. His diagnosis requires a peritoneal biopsy. The treatment is not completely established. Surgical treatment is difficult, involving viscerolysis and multiple incisions of the fibrous membrane. Despite the current progress in therapeutic management, the prognosis remains pejorative, with significant mortality.

Hydatid cyst prolapsed in a hernia sac.

A 70-year-old patient with a 20-year history of  gastric ulcer intervention presented for an abdominal mass appeared for 3 years . The clinical examination found a herniation on the median abdominal scar which is containing an irregular mobile renient mass. Computed abdominal tomography had objectified two voluminous liquid multilocular formations completely prolapsed in the hernia sac.

Laparoscopic treatment of a cephalic pancreatic leiomyoma.

BACKGROUND: Leiomyoma of the pancreas is very rare. Symptoms and signs are not specific. It has the clinical presentation of a pancreatic mass. The preoperative clinical and radiological assessments are fundamental to establish a therapeutic schema. The curative treatment is surgical resection. A methodical histological examination is required to confirm the final diagnosis of Leiomyoma. CASE REPORT: A 52-year-old female patient presented with a mass of the head of the pancreas. After preoperative assessment, the patient had laparoscopic enucleation. Postoperative course was no remarkable for complications. Pathology examination concluded to leiomyoma. CONCLUSION: Preoperative diagnosis of pancreatic leiomyoma is difficult. It has the features of a pancreatic mass. The preoperative assessment aims to identify signs of malignancy. In its absence, laparoscopy is feasible and safe. Enucleation, if indicated, is a surgical option for a benign disease sparing the patient a pancreatic resection.

Surgical management of primary crohn's disease. descriptive study about 226 patients.

BACKGROUND: The surgery is required in more than 80% of patients with Crohn's disease (CD). Studies before confirm the specific genetic variation of CD in the Tunisian population compared with the others ethnic groups. AIM: This article aims to study the epidemiological, anatomical and therapeutic principles of surgical forms of CD in a cohort of Tunisian patients. METHODS: We report a retrospective study from January 1998 to September 2010 that studied 226 patients originated only from Tunisia (in North Africa), operated on for MC. We had been interested in epidemiological, anatomical, clinical, therapeutic, topographic progression of the disease, the procedure and the postoperative follow-up. RESULTS: The median age was 33 years. The average time between the onset of the disease and the surgical procedure was 31 months. The diagnosis of CD was established preoperatively in 213 patients (94%). The diagnosis was made intraoperatively because of an acute complication in 5 cases (2.2%) and postoperatively in 8 cases (3.5%). The most common location was the ileocecal junction in 184 cases (81.4%). Achieving the most common was the mixed form (stricture and fistula) in 123 cases (54.4%). Operative mortality was 0.04% (n = 1). Specific morbidity was 8.4% (n = 19). In long term, a surgical recurrence was noted in 17 patients (7.5%). In multivariate analysis the independent risk factors for surgical recurrence were: smooking (p = 0.012, ORs = 3.57) and post-operative medical treatment (p = 0.05, ORs = 2.6). CONCLUSIONS: Achieving stenosing and fistulizing the ileocecal junction is the most frequent surgical form in Crohn's disease. Our series is unique for a lower rate of the postoperative recurrence (7.5%).

Anal imperforation in adults: Diagnostic difficulties and therapeutic options.

Anorectal malformations are congenital anomalies ranging from simple perineal fistulas to complex malformations. They are usually treated inchildhood, and exceptionally in adult. We herein report the case of a 22 years aged patient and relate the diagnosis difficulties and therapeuticoptions. She consulted for anal imperforation discovered since birth. Initially, His parents refused the surgical management. It was an analimperforation with a vestibular fistula. The patient was operated by a low approach. She had a disconnection of the recto-vestibular fistula,dissection of the anal canal and a perineal posterior transposition. Postoperative course was uneventful. The evaluation of continence usingKelly's score found good Functional result.

Laparoscopic ileo-cecal resection: the total retro-mesenteric approach.

BACKGROUND: Ileo-cecal resection is the most performed procedure in Cohn's disease. In the last decades, the laparoscopic approach became the gold standard. The dissection can be lateral to median or median to lateral. In non-malignant diseases as it is the case for Crohn's disease, the most performed dissection approach is the lateral to median. Herein, we describe a technique performed in our department: the total retro-mesenteric approach. METHOD: The procedure requires 4 trocars with a 10- to 12-mm median suprapubic trocar. The telescope is placed in this trocar. The dissection will begin with the opening of the mesentery root creating a retro-mesenteric tunnel. This dissection gives a direct visualization of the duodenum, of the ureter and the gonadic vessels which guarantees a safe procedure considering the importance of the inflammation in this disease. At the end of the retro-mesenteric step, the right colon is only attached to the Toldt's fascia. The transection of the mesentery is done next to the bowel wall leaving at the end the choice to the surgeon to perform an extra- or endocorporeal anastomosis. RESULTS: This retro-mesenteric approach has been used in our department since 2004. Until May 2013, 89 patients underwent laparoscopic resection for Crohn's disease with a mean operative time of 130 min, a morbidity rate of 6 % and a laparoconversion rate of 13.6 %. CONCLUSION: We describe the total retro-mesenteric approach in the ileo-cecal resection for Crohn's disease. The approach is considered to be safe allowing the surgeon to perform a dissection far from the inflammatory site and allowing a visual identification of the duodenum and the right ureter. The morbidity of the procedure is equivalent to the other dissection techniques.

Laparoscopic resection of gastric stromal tumors.

Gastro-intestinal stromal tumors (GIST) are the most common mesenchymal gastrointestinal tumors. The Gastric location represents 60% of cases [1,2]. Complete surgical excision remains the treatment of reference for the localized forms. This surgery can be made by laparoscopy when the lesion's size doesn't exceed 5 cm. Some principles must e respected: a mono-block complete surgical resection, with healthy margins and without effraction. This technique will be reserved for trained teams and for selected cases according to the size and location. We herein try to explain the surgical laparoscopic excision of gastric stromal tumors explaining .

Solid-state dye-sensitized solar cells based on poly(3,4-ethylenedioxypyrrole) and metal-free organic dyes.

Poly(3,4-ethylenedioxypyrrole) (PEDOP), combined with metal-free organic sensitizers, is efficiently used for the first time as the hole-transporting material in solid-state dye-sensitized solar cells. Devices employing PEDOP as the hole conductor and D35 or D21 L6 as the sensitizer show a ten-times-higher energy-conversion efficiency (of 4.5% and 3.3%, respectively) compared to Ru-Z907-based devices. This is due to the efficient suppression of electron recombination.

Incorporation of cobalt-ferrite nanoparticles into a conducting polymer in aqueous micellar medium: strategy to get photocatalytic composites.

In this study an easy strategy for conducting polymer based nanocomposite formation is presented through the deposition of cobalt-ferrite (CoFe(2)O(4)) containing poly(3,4-ethylenedioxythiophene) (PEDOT) thin layers. The electrochemical polymerization has been performed galvanostatically in an aqueous micellar medium in the presence of the nanoparticles and the surface active Triton X-100. The nanoparticles have been characterized by Transmission electron microscopy (TEM), the thin layers has been studied by applying Scanning electron microscopy (SEM), and X-ray diffraction (XRD), and the basic electrochemical properties have been also determined. Moreover, electrocatalytic activity of the composite was demonstrated in the electrooxidation reaction of dopamine (DA). The enhanced sensitivity - related to the cobalt-ferrite content - and the experienced photocatalyitic activity are promising for future application.

Predictive factors of Gastrointestinal motility Dysfunction after gastrojejunostomy for peptic ulcer stenosis.

BACKGROUND: Despite the establishment of effective medical therapies in peptic ulcer disease, gastric outlet obstruction remains one of the most common health problem in Tunisia. Various operations have been attempted, which may lead to postoperative morbidity. Gastrointestinal (GI) motility dysfunction is the most common complications. AIM: to determine the predictive factor of gastrointestinal motility dysfunction after gastrojejunostomy for peptic ulcer stenosis. METHODS: We carried out a retrospective study to evaluate the postoperative recovery of the motility of the upper gastrointestinal tract after gastrojejunostomy for peptic ulcer stenosis. During the 9- year study, 138 patients underwent operations for ulcer peptic stenosis. Among the patients, 116 (84,1%) were treated with gastrojejunostomy. Descriptive statistics, univariate and multivariate analyses were performed. RESULTS: The mean age of patients was 47.85 years (range: 19- 92years) and most. Were male (84, 5 %). Ninety two (79.3%) patients had a documented history of peptic ulcer disease. The duration of symptoms ranged from 10 to 372 days (mean: 135.86 days). Eighty two (71%) patients were operated on through laparotomy. Laparoscopic procedure was performed in 29% of the patients. There was no operative mortality. Perioperative morbidity occurred in 12.4% (14 patients). Gastrointestinal motility dysfunction occurred in 12 patients (10.3%). It was treated by nasogastric aspiration and prokinetics. By univariate analysis; diabetes (0,010), cachexia (0,049), ASA class (0.05) were all statistically associated with gastrointestinal motility dysfunction in this series. Multivariate logistic regression analysis (table 2) showed that the cachexia (0,009), ASA class (0.02) were the main predictors of gastrointestinal motility dysfunction after gastrojejunostomy for peptic ulcer stenosis in the followed patients. CONCLUSION: Gastrointestinal motility dysfunction is the most common complications after gastrojejunostomy for pyloric adult stenosis. Surgery must be preceded by careful medical preparation. It is more likely to occur in patients with an ASA class 2 or greater. Those patients should be considered for other treatment options, such as endoscopic balloon dilation.

[Surgical management of entero-vesical fistulas in Crohn's disease]. / Traitement chirurgical des fistules entéro-vésicales secondaires à la maladie de Crohn.

BACKGROUND: Crohn's disease (CD) is a chronic inflammatory disease of the intestine that can cause an attack by contiguity of the urinary tract. Although the shape is common and fistulizing 35% of all patients with CD, entero-urinary fistulas are rare and only seen in 2-8% of patients. aim: To report the frequency of occurrence of this complication among the group of surgical forms of CD. Describe the different pathophysiological mechanisms of occurrence of entero-vesical fistula (EVF) during the CD. methods: We report, retrospectively, seven observations of EVF complicating MC made during the period from 01/01/1998 until 31/12/2010. results: The mean age of patients was 30 years. There were 3 men and 4 women. All patients had clinical signs and radiological EVF. In six patients, CD was ileo-caecal and the ileo-vesical fistula was between the last loop and the bladder. In one patient, the CD was located only in colon, and the fistula was between sigmoid colon and bladder. Level of the bladder, it was a false EVF in five patients and a true EVF in two patients. In these last two, the fistula of 2 mm, was on the top of the bladder. Treatment consisted in all cases by a disconnect between the digestive tract and bladder, resection with restoration of digestive continuity, and if the case of true EVF, a freshening the edges of the fistula with suture of the bladder's wall and drainage. The postoperative course was uneventful in six patients and marked by an outbreak intraperitoneal abcess in one patient who had evolved under medical treatment. After a mean of eleven months, no recurrence surgery was noted. CONCLUSION: Despite advanced treatment in the context of CD, the indication in EVF is a surgical treatment. Surgery helps fight against the consequences of septic urinary tract, but also to launder bowel disease and reduce the risk of recurrence in the short term.

Multiscale investigation of pore structure heterogeneity in carbonate rocks using digital imaging and SCAL measurements: A case study from Upper Jurassic limestones, Abu Dhabi, UAE.

This study presents a comprehensive analysis of rock properties for a selected group of six carbonate reservoir rock samples revealing complex structures at various length scales. Experimental laboratory methods as well as image analysis techniques were conducted in this study to characterize the macro- and micro-pores in mud- and grain-dominated limestones samples from the Upper Jurassic Arab Formation (Arab D member). Mercury Injection Capillary Pressure (MICP), porosimeter, and permeameter lab measurements were employed to assess the pore network heterogeneity and complexity. In addition, a multiscale rock imaging approach was implemented to detect grain and pore phases at several length scales using Thin Sections (TS), Scanning Electron Microscopy (SEM), Focused Ion Beam Scanning Electron Microscopy (FIB-SEM), as well as 3D X-ray Computed Tomography (CT), and micro-computed tomography images (MCT). Furthermore, the multifractal analysis method was applied on the MICP and FIB-SEM to characterize quantitatively the heterogeneity of the pores in the studied samples. Heterogeneous samples 3R, 4M, 5W, and 6M display the highest non-uniformity degree Δα values, falling within the range of [1.21, 1.39] based on FIB-SEM images. Samples 1G, 2R, 3R, and 5W exhibit more heterogeneous pore structure, with Δα values ranging from 0.73 to 1.49 based on the MICP experiments. The results and findings confirm the effectiveness of multifractal parameters Δα and the asymmetry degree in the vertical axis Δf(α) in quantifying and characterizing rock heterogeneity.

A four-Axis-Method to Evaluate a Part of an Undergraduate Medical Students' Curriculum.

Introduction: The evaluation of programs in faculties of medicine enables them to adequately reach their mission objectives, and social responsibilities and to correct their potential lacune. Few publications have described the process of internal evaluation of a program performed by the organizational members. The authors aimed to describe a practical method called the four-axis method to assess curriculum using a practical example. Methods: The authors performed a descriptive study, highlighting the application of a particular method of evaluation of a program called the four-axis method. It consisted of the assessment of the pedagogical alignment [1], teaching techniques and evaluation tests [2], students' viewpoints and needs [3], and the teachers' opinions and needs [4]. To contextualize this method, the authors described a practical experience of the assessment of a multidisciplinary theme (theme 16), which is taught during the second year of medical education. Was performed the evaluation from January 2020 to January 2021. The population studied consisted of the tutors implicated in the teaching of the theme and the students in the second year of medical education who accepted to answer the satisfaction questionnaires. The students and tutors who did not fill out the questionnaires were excluded. No statistical tests were needed because of the descriptive nature of the study. Results: The most relevant results highlighted that 48.4% of the teachers did not systematically use bioclinical cases involving interactions between students; also, 42.4% of the students believed that the teaching sessions didn't introduce practical examples giving rise to interactions between them. Therefore, the 4-axis-based analysis indicated that weaknesses were mostly attributed to the lack of homogeneity in the teaching methods and techniques which showed the teachers' difficulties in integrating clinical data into their teaching so that they can help the students to assimilate the fundamental data. Conclusion: The authors' used a particular approach since it focused both on an objective evaluation of the teaching methods and the evaluation tests and the students' and teachers' viewpoints and needs. The major limitation of this approach was the fact that it could not integrate the educational environment that could impact the students' performances.

Enhancing Student Success: Implementing Mentoring Programs in Academic Settings: Focus on the Faculty of Medicine of Tunis.

In order to improve the learning outcomes, skills, sense of belonging and well-being of their students, faculties around the world have chosen to implement mentoring programs for their learners. Given the complexity of implementing this approach, our objectives in this review are, on the one hand, to discuss and support the principles and recommendations of a mentoring project in an academic setting and, on the other hand, to present the vision of the Faculty of Medicine of Tunis regarding this mentoring approach.

[Sigmoid diverticulitis]. / Les sigmoidites diverticulaires.

BACKGROUND: The sigmoid diverticulitis is the most common complication of diverticulosis of the colon. The remaining questions concern the current risk factors for recurrence after a first acute episode, radiological asking immediately upon suspicion of diverticulitis and therapeutic management including the indications of surgical treatment, what to conduct and its principles. METHODS: Literature review. RESULTS: Risk factors of recurrence are: persistent or recurrent diverticulitis, abscess, stenosis and / or fistula. Abdominal CT is recommended in all patients clinically suspected diverticulitis of the colon. Treatment of acute diverticulitis is medical. The emergency surgical treatment depends on the stage of Hinchey. Stage I: In case of failure of medical treatment, resection-anastomosis in an emergency time delay to be proposed. Stage II: a percutaneous drainage followed by resection-anastomosis in 1 time. Stage III: surgery in emergency sigmoid colectomy based on. Stage IV: Hartmann procedure is the procedure of reference. Prophylactic colectomy is proposed in the case of presence of risk factors of recurrence. CONCLUSION: Comparison with other literature review were allowed to find that ultrasound made by an experienced radiologist could replace abdominal CT, and for stage III and IV Hinchey, laparoscopic resection can be performed with an immediate restoration of digestive continuity in well selected patients.

The Design and Validation of a Self-Assessment Questionnaire of Critical Appraisal of Medical Literature Skills in Medical Students.

Introduction: Critical appraisal of medical literature is a challenging step of the evidence-based medicine practice. Many assessment questionnaires have been published in the literature, but they have mainly focused on all the evidence-based medicine practice process. The authors aimed to develop and validate a questionnaire assessing the critical appraisal skills of medical students from the same Faculty. Methods: The questionnaire was developed by item generation through a review of the literature and an expert committee. The questionnaire was validated in terms of content validity and construct validity. Fitness of data for analysis was checked through Kaiser-Meyer-Olkin (KMO) and Bartlett's sphericity. Construct validity was carried out using a principal axis exploratory factor analysis (EFA) with 'varimax' rotation to study the internal structure of the questionnaire and to extract the test major factors. The questionnaire was administrated to a cohort of under and postgraduate medical students (n=84) to evaluate the test reliability and select the best items. The reliability of the questionnaire was assessed by Cronbach's alpha coefficient to evaluate the internal consistency. The correlations between the self-confidence and satisfaction dimension score, the critical thinking dimension score, the learning style dimension score, the Fresno-adapted test scores and the total score were assessed using the Spearman's correlation test. Results: The questionnaire consisted of 31 items. A factorial analysis grouped the items into 3 dimensions that consisted of the self-confidence and satisfaction dimension, the critical thinking dimension and the learning style dimension. Cronbach's alpha accounted for 0.95, CI95% [0.9-1] for the entire questionnaire. The factor analysis explained 79.51% of the variance. The external validity assessment based on a Spearman's correlation study highlighted a weak correlation between the total scores and the critical thinking dimension and the self-perception and satisfaction dimension. Conclusion: In spite of the limitations of this study, mainly the small number of the students recruited, the questionnaire seems to measure with adequate reliability the competences of under and postgraduate medical students.

A qualitative study about critical appraisal of medical literature learning among medical students.

INTRODUCTION: Skills in critical appraisal of medical literature are compulsory to achieve in medical practice. This step is the third step of the evidence-based medicine process whose main role is to bridge a gap between scientific evidence and practice. Acquiring skills in critical appraisal of the literature has been reported to be challenging for the trainees with different limits according to their levels, backgrounds or specialties. AIM: To assess the limits and factors influencing the practice of appraising literature of different students from the same faculty. This faculty included training of biostatistics and preventive medicine in the curriculum during the first 2 years of medical education without linking this learning to the evidence-based medicine practice. METHODS: The authors performed a qualitative study including volunteers who attended voluntarily the same training about critical appraisal of medical literature. The study was based on a satisfaction questionnaire fulfilled by all the participants at the end of the training and on an individual semi-structured interviews programmed 3 months after the training. The satisfaction questionnaire was rated by the authors. The authors proceeded also to a content analysis of the interviews following 3 steps: pre-analysis, treatment of the results, and interpretation. RESULTS: All the participants (95) fulfilled the questionnaire. The satisfaction's mean score revealed a general moderate satisfaction. Eleven students agreed to be interviewed: Five students from the third year of medical education, 2 students from the second year of medical education, 2 postgraduate students and 2 family doctors. The main themes discussed by the interviewees consisted of training organization, the assessment, the impact on research and the impact on the care process. CONCLUSION: To promote EBM learning, medical students first need to actively participate to interactive learning, introduced early and gradually into the curriculum and integrating all specialties including postgraduate students.

Experimental and digital investigations of heterogeneity in lower cretaceous carbonate reservoir using fractal and multifractal concepts.

Characterization and prediction of reservoir heterogeneity are crucial for hydrocarbon production. This study applies the multifractal theory using both numerical and experimental data to characterize quantitatively the heterogeneity of pore structures in Lower Cretaceous limestone reservoir from the United Arab Emirates. Fractal dimensions calculated from three dimensional digital images showed good correlation (R2 = + 0.69) with experimental high-pressure mercury injection (HPMI) measurements. Moreover, both experimental and numerical fractal dimensions correlate well with experimental HPMI porosity measurements. Multifractal parameters such as the non-uniformity degree of the pore structures Δα, the asymmetry degree in the vertical axis Δf(α), the concentration of pore size distribution α0 and the asymmetry degree in the horizontal axis Rd estimated from digital and experimental data correlated well and revealed ability to quantitatively describe samples heterogeneity. The ranges of digital and experimental multifractal parameters provided the means to differentiate between homogeneous and heterogeneous samples.

Is critical thinking potential correlated to critical appraisal skills of medical literature?

INTRODUCTION: Critical appraisal of medical literature is a mandatory skill to practice evidence-based medicine. The relation between the critical appraisal skills and the critical thinking potential has been rarely assessed in the literature. AIM: To assess the relation of critical thinking potential to critical appraisal of medical literature competencies. Besides, they tried to highlight the variation of the critical thinking potential according to the students' level. METHODS: The authors conducted a mixed study associating a quantitative and a qualitative approach. The study included second year (SYME), third year (TYME) and postgraduate medical students (CME) and family doctors (FD) from the same faculty of medicine. All the students received the same active training focused on critical appraisal of medical literature. They were asked to fulfil a pre-requisite test and a self-assessment questionnaire before the training session and a final test after the training. The self-assessment questionnaire was conceived by an expert committee and assessed the main characteristics of critical thinking consisting of sensitivity to context, self-correction and search for criteria. Three months after the training, the students were interviewed using a semi-structured interview. The SPSS software 16.0 was used. RESULTS: In our study, 58.9% of the students presented a high critical thinking potential profile. Their scores varied according to their levels with better scores in SYME and FD and intermediate scores in TYME and CME. The pre-requisite test scores varied according to the critical thinking profile and the level. On the other hand, final test scores didn't differ according to the critical thinking profile or the level. CONCLUSION: Our results put emphasis on the variation of the critical thinking potential according to the students' levels. The better results of the SYME students in comparison to those in the TYME put emphasis on the necessity of changing curriculum in order to enhance the sensitivity and the inclination of the students.