Low back-pain among school-teachers in Southern Tunisia: prevalence and predictors.

OBJECTIVES: In the professional environment, low back pain (LBP) is a multifactorial symptomatology, despite scientific and technological advances in the design and the arrangement of increasingly ergonomic workstations. Teachers are not exempt from this risk, due to prolonged sitting or standing. In light of this, this study aimed to estimate LBP prevalence among teachers in Southern Tunisia and to identify their determinants. METHODS: It was a cross-sectional study including a representative sample of teachers from secondary, middle, and primary schools in Sfax, Tunisia, conducted during the period March-April 2021. LBP intensity was assessed using a visual analog scale from 1 to 10. A severe LBP was defined as VAS≥7. RESULTS: Among the participants, 292 teachers were females (55.6 %). The median age was 48 years (Interquartile Range (IQR)=[41-53] years). Overall, 377 teachers had a severe LBP, with a global prevalence of 71.8 %. Multivariate analysis showed that independent determinants of LBP among teachers were female gender (Adjusted Odds Ratio (AOR)=2.81;p<0.001), age ≥30 (AOR=5.68;p=0.009), chronic diseases (AOR=2.52;p<0.001), working at primary schools (AOR=1.75;p=0.033), working for ≥4 h per day (AOR=2.41;p=0.005), inadequate ergonomic conditions at work (AOR=1.78;p=0.008) and distance home-school ≥10 km (AOR=2.27;p=0.003). CONCLUSIONS: This study demonstrated that LBP among teachers was alarmingly high. Different individual, ergonomic, and occupational factors were predictors of this symptom. Thus, development of rational strategies for LBP prevention among teachers and the improvement of working conditions are urgently needed.

COVID-19-Related Fear and Mental Distress Among Tunisian Primary, Middle and High School Teachers: Prevalence and Predictive Factors.

This study aimed to determine the prevalence and predictive factors of fear of COVID-19 and serious mental distress among teachers in public schools of Southern Tunisia. This was a cross sectional study among a representative sample of 525 teachers. The level of Fear was assessed using the Fear of COVID-19 Scale (FCV-19S). A high level was defined as an FCV-19S ≥ 22. Kessler 6 (K6) was performed to predict serious mental distress. Serious mental distress was defined as a K6 score ≥ 13. The prevalence rates of high level of fear of COVID-19 and serious mental distress were 32.8% and 63.8%, respectively. Independent factors associated with a high level of fear of COVID-19 were female gender (Adjusted odds ratio (AOR)=1.6 [1.1-2.5]), chronic disease (AOR=1.6 [1.1-2.4]), home-living children (AOR=3.3 [1.4-7.8]), and poor material working conditions (AOR=1.5 [1.2-2.1]). The high level of fear of COVID-19 (AOR=3.1 [1.8-5.1]) was independently associated with serious mental distress. Living in a rural area (AOR=0.4 [0.3-0.8]), previous COVID-19 infection (AOR=0.5 [0.4-0.8]) and going to school on foot (AOR=0.3 [0.2-0.51]) were independently associated with a lower prevalence of serious mental distress.

Adverse effects of personnel protective equipment among first line COVID-19 healthcare professionals: A survey in Southern Tunisia.

BACKGROUND: Health care professionals (HCP) were obliged to wear personal protective equipment (PPE) during pandemic in order to minimize the risk of transmission of the emerging virus. The objective of the study was to estimate the prevalence of adverse effects related to the wear of PPE among HCP and to determinate their predictive factors. METHODS: This was a cross-sectional study including a representative sample of 300 randomized HCP at Hedi Chaker University Hospital Sfax, Tunisia, during the period August-September 2021. Data collection was carried out by an anonymous self-administered questionnaire. RESULTS: PPE related adverse effects were noted among 87 HCP with a prevalence of 57.2%. Multivariate analysis showed that factors independently associated with PPE adverse effects were female gender (Adjusted Odds Ratio (AOR) = 1.8; p = 0.048), chronic diseases (AOR = 0.29; p = 0.001) and previous infection with COVID-19 (AOR = 0.46; p = 0.004). Frequent use of bleach or other disinfection product without protection and use of hot water at work were independently associated with a high risk of adverse effects ((AOR = 2.22; p = 0.003) and (AOR = 2.83; p = 0.005), respectively). Similarly, a duration of use of PPE>4 h per day (AOR = 1.98; p = 0.039), as well as use of visors and/or glasses (AOR = 1.84; p = 0.045) were independently associated with PPE related adverse effects. CONCLUSION: The prevalence of adverse effects related to the wear of PPE was alarmingly high among HCP. Multiple risk factors were highlighted, notably professional aspects. Adequate and repetitive training for caregivers on the correct use of PPE remain essential to manage this problem.

The Effect of Topical Tranexamic Acid in Endoscopic Sinus Surgery: A Triple Blind Randomized Clinical Trial.

OBJECTIVE: Our aim is to evaluate the effect of topical tranexamic acid (TA) on bleeding and surgical quality field in the functional endoscopic sinus surgery (FESS). METHODS: A total of 74 patients who underwent FESS due to chronic rhinosinusitis were included. The patients were randomized into 2 groups. TA group (n = 37) received a topical cotton pledget soaked with TA and placebo (PL) group (n = 37) received a pledget soaked with saline solution. RESULTS: A significant effect was noted for the TA group versus the PL group in the grade 1 of the Boezaart scale at 35 minutes (4 for TA group and no case for PL group). This effect was absent for higher grades. We did not notice a significant effect between the 2 groups at 5 minutes. Blood loss was 359 ml in the TA group versus 441 ml in the PL group. No significant change was observed between the 2 groups concerning the blood parameters. No side effects were reported. CONCLUSION: Despite its safety when administrated locally and its low cost, TA provides limited effect on quality of surgical field after 35 minutes of the start of FESS in the patients with chronic rhinosinusitis. This effect was absent at the start of the intervention and when analyzing the blood loss and hematologic parameters.

Prevalence and Factors Affecting Willingness to Accept or Refuse Vaccination against COVID-19 among Healthcare Professionals in Southern Tunisia.

BACKGROUND: The COVID-19 pandemic continues to spread throughout the world causing serious morbidity and mortality. Health care professionals (HCP) are on the front line in the face of this pandemic and are identified as priorities for COVID-19 vaccination. This study aimed to estimate the acceptability rate of the COVID-19 vaccination among HCP and to identify their predisposing factors. Methods: This was a cross-sectional study using an anonymous self-administered questionnaire including a randomized sample of HCP in Southern Tunisia, on March-April 2021. Results: Among 300 participants, the COVID-19 vaccine acceptability rate was 65.3%. Factors independently associated with vaccine acceptability were age groups <30 years [Adjusted Odds Ratio (AOR)=4.36; p = 0.002)], urbanity of residence (AOR = 3.44; p = 0.027), medical professional category (AOR = 2.69; p = 0.023) and caring for coronavirus infected patients (AOR = 2.32; p = 0.047). Belief that COVID-19 vaccination is important to work safely as a health care provider (AOR = 3.26; p = 0.013), should be available for all HCP (AOR = 17.98; p = 0.004) and has been quickly developed before it has been thoroughly vetted and tested for efficacy and safety (AOR = 5.88; p < 0.01) were independently associated with willingness to accept vaccine. Planning to get a COVID-19 vaccine for the next years and recommending it to the family were independent predictive factors of accepting COVID-19 vaccine ((AOR = 6.88; p < 0.001) and (AOR = 25.03; p < 0.001), respectively).Conclusion: The acceptance rate of vaccination against COVID-19 among Tunisian HCP is still low in South Tunisian hospitals. Socio-demographic, cultural and professional factors predisposing to the vaccination willingness were highlighted. Combating the vaccine hesitancy of HCP through enhancing sensibilization campaigns is essential to promote vaccination in general population.

Characteristics of Obese Patients with Acute Hypercapnia Respiratory Failure Admitted in the Department of Pneumology: An Observational Study of a North African Population.

BACKGROUND: Acute hypercapnic respiratory failure (AHRF) is a common life-threatening event in patients with obesity hypoventilation syndrome (OHS). OBJECTIVES: To study the clinical pattern, noninvasive ventilatory support, as well as the short- and long-term outcomes of patients with OHS admitted in a ward because of AHRF. METHODS: We conducted a retrospective cohort study including all adults with OHS aged ≥ 18 - year - old, admitted in a 90-bed-ward for AHRF. RESULTS: A total of 44 patients were included. Fifteen (34.1%) and 29 (65.9%) patients were diagnosed with malignant OHS (mOHS) and nonmalignant OHS (non-mOHS), respectively, while 36 (81.8%) had coexisting obstructive sleep apnea hypopnea syndrome (OSAHS). Patients with mOHS had a significantly higher rate of heart failure (100% vs. 31%; p < 0.001), chronic renal insufficiency (CRI) (73.3% vs. 41.4%; p = 0.04), and dyslipidemia (66.7% vs. 34.5%; p = 0.04) than those with non-mOHS. The mean forced vital capacity (FVC) in our patients was of 59.5% ± 18.5 of the predicted value, lower than what is usually reported in stable patients with OHS. At hospital admission, more than two-thirds (n = 34, 77.3%) were misdiagnosed as having asthma exacerbation (n = 4, 4.9.1%), chronic obstructive pulmonary disease (COPD) exacerbation (n = 12, 27.3%) and/or heart failure (n = 29, 65.9%). Acute pulmonary oedema (ACPE) (n = 16, 36.4%) and acute viral bronchitis (n = 12, 27.3%) were the main identified causal factors, while no cause could be determined in 5 (11.4%) patients. Noninvasive positive pressure ventilation (NIPPV) using bilevel positive airway pressure (BIPAP) was very highly effective to treat AHRF, with only 2.27% of patients failing the modality. Median overall duration of ventilation was 9 hours per day (1.3-20) and was significantly longer in patients with mOHS than in those with non-mOHS (10 [6-18] vs. 8 [1.3-20], respectively; p = 0.01). Forty two of the forty-three patients discharged alive were treated with BIPAP or continuous positive airway pressure (CPAP) in 26 and 16 patients, respectively. The probability of survival was 90% at 12 months, while the probability of readmission for a new episode of AHRF was 56% at 6 months and 22% at 12 months, respectively. CONCLUSION: AHRF in OHS patients is a life-threatening event which can be successfully and safely treated with BIPAP, with a low long-term mortality even in patients with mOHS.

Molecular epidemiology of extended-spectrum beta-lactamase-producing Escherichia coli in Tunisia and characterization of their virulence factors and plasmid addiction systems.

BACKGROUND: Extended-spectrum ß-lactamases (ESBLs), particularly CTX-M- type ESBLs, are among the most important resistance determinants spreading worldwide in Enterobacteriaceae. The aim of this study was to characterize a collection of 163 ESBL-producing Escherichia coli collected in Tunisia, their ESBL-encoding plasmids and plasmid associated addiction systems. RESULTS: The collection comprised 163 ESBL producers collected from two university hospitals of Sfax between 1989 and 2009. 118 isolates harbored blaCTX-M gene (101 blaCTX-M-15 gene and 17 blaCTX-M-14 gene). 49 isolates carried blaSHV-12 gene, 9 blaSHV-2a gene and only 3 blaTEM-26 gene. 16 isolates produced both CTX-M and SHV-12. The 101 CTX-M-15-producing isolates were significantly associated to phylogroup B2 and exhibiting a high number of virulence factors. 24 (23.7%) of the group B2 isolates belonged to clonal complex ST131. Pulsed-field gel electrophoresis (PFGE) typing revealed a genetic diversity of the isolates. 144 ESBL determinants were transferable mostly by conjugation. The majority of plasmid carrying blaCTX-M-15 genes (72/88) were assigned to various single replicon or multireplicon IncF types and had significantly a higher frequency of addiction systems, notably the VagCD module. CONCLUSION: This study demonstrates that the dissemination of CTX-M-15 producing E. coli in our setting was due to the spread of various IncF-type plasmids harboring multiple addiction systems, into related clones with high frequency of virulence determinants.

[Adolescent's hospital morbidity in Sfax - Tunisia]. / La Morbidité Hospitalière Des Adolescents à Sfax - Tunisie.

BACKGROUND: Adolescents present specific sanitary needs, linked to the physical and psychological mutations that occur during this vulnerable period of life. These needs remain little known in Tunisia. But : To describe epidemiological profile of morbidity of teenagers hospitalized in Hedi Chaker's hospital center of Sfax, during a period of 5 years, between 2003 and 2007. METHODS: Data exploitation of the descriptive survey of morbidity and mortality of hospitalized adolescents. RESULTS: During the study, 2963 adolescents of 10 to 19 years have been hospitalized (5.1 % of total of hospitalizations). Paediatrics received 36.9 % of adolescents. Paediatrics, haematology and infectious diseases's services received 58.5 % of them. According to the groups of diagnosis, genitourinary and endocrine's diseases, dominate for girls, whereas infectious and parasitic diseases and tumors touched more boys. Diabetes, signs and general symptoms, leukaemia and anaemia, were the most frequent pathologies. CONCLUSION: Taking care of teenagers is often parcelled out on several hospitable services. Therefore, the improvement of the greeting services, in order to answer the teenager's relational needs home a temporary solution, while hoping, the setting up of units or specific services of adolescents that showed evidence of their utility for the development of the medicine of the teenagers in the industrialized countries.