Effectiveness of a health education program on mothers' knowledge and practice regarding amebiasis.

This study was conducted to assess the effectiveness of a health education program on mothers' knowledge and practices related to amebiasis. Pre- and post-I and II-tests were used, along with a two-group quasi-experimental design. The study included a convenience sample of 120 mothers, including 60 from the study and 60 from the control group. Out of the entire number of PHCs in Wasit Governorate, seven were used for the study. A three-part structured questionnaire tests mothers' knowledge of the illness and attitudes about it. The results of this study indicated that there is statistically significant difference between the study and control groups during the post-test I and post-test II periods (t=14.968, P=.000 and t=13.731, P=.000, respectively). Data from the study group during the pre-test period of 31.17(9.14) revealed that (70%) of mothers had bad practices connected to Entameba Histolytica among children. According to the post-test I results, 47.4 (9.48) respondents, or 70%, identified good practices. The main finding showed that, after the educational program was implemented, mothers' knowledge and practice of amebiasis dramatically increased, with pre-post implementation differences that are statistically significant.

Prevalence and impact of diabetes mellitus in hospitalized COVID-19 patients in a Tunisian Center: a cross-sectional study.

Background: The outbreak of the coronavirus disease 2019 (COVID-19) has become an evolving worldwide health crisis. With the rising prevalence of diabetes mellitus has come an increasing awareness of their impacts on infectious diseases, and the risk for postinfection complications and mortality from critical infections. Objective: The objective of this study was to evaluate the prevalence and impact of diabetes mellitus on the severity and mortality of COVID-19. Methods: Data of laboratory-confirmed hospitalized patients at the COVID-19 unit between September 2020 and August 2021 were analyzed, in a cross-sectional study. The population was classified into two groups: COVID-19 patients with and without diabetes. Primary outcomes were the overall length of hospital stay, the admission to the ICU, and death. The association between diabetes and death was assessed in a Cox proportional hazards model. Results: A total of 866 patients were included. There were 270 (31.2%) patients with diabetes. Diabetic patients were more likely to have hypertension (58.1 vs. 33.4%), cardiovascular disease (18.5 vs. 10.4%), and dyslipidaemia (17.8 vs. 7.2). Overall, 263 patients died, among them only 86 in the diabetic group (P=0.523). Patients with diabetes had a higher risk of developing complications (P<0.001). Multivariate Cox regression analysis showed that diabetes was not significantly associated with death [HR (95% CI): 1.253 (0.963-1.631)]. Conclusion: Diabetes was associated with a greater risk of complications in patients with COVID-19. Special attention to diabetic patients during treatment must be given to avoid these complications.

Prevalence of comorbid asthma in Tunisian patients with COVID-19: clinical features and outcomes.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has resulted in around 1 million COVID-19 infection cases and over 29,000 deaths in Tunisia thus far. There is great variability in the prevalence of asthma among patients with COVID-19, but the impact of asthma on patients with COVID-19 is not clear. We sought to describe the clinical features of Tunisian patients with COVID-19 and to compare asthmatic and non-asthmatic patients. METHODOLOGY: This retrospective study included 675 Tunisian patients who were hospitalized with COVID-19. Clinical characteristics were collected from medical records. Bivariate analyses and multivariate regression models were used to assess the associations between asthma and the risk of severe symptoms, including death/recovery. RESULTS: The prevalence of asthma in the sample was 14.5%. The results show that asthmatic patients with COVID-19 have significantly less severe symptoms and better outcomes than non-asthmatic patients. CONCLUSIONS: Asthma was not found to be associated with higher severity or worse prognosis among patients with COVID-19 in Tunisia.

Antibiotic stewardship team in a Tunisian university hospital: A four-year experience.

BACKGROUND: Association between antibiotic use and antimicrobial resistance has been demonstrated in several studies; hence the importance of antibiotic stewardship programs (ASPs) to reduce the burden of this resistance. AIM: To describe the antibiotic stewardship team (AST) interventions in a Tunisian university hospital. METHODS: a cross-sectional study was conducted in the infectious diseases department in Sousse-Tunisia between 2016 and 2020. Hospital and private practice doctors have been informed of the existence of an antibiotic stewardship team. Interventions consisted of some helps to antibiotic therapy (i.e.; prescription, change or discontinuation) and/or diagnosis (i.e.; further investigations). RESULTS: Two thousand five hundred and fourteen interventions were made including 2288 (91%) in hospitalized patients, 2152 (86%) in university hospitals and 1684 (67%) in medical wards. The most common intervention consisted of help to antibiotic therapy (80%). The main sites of infections were skin and soft tissues (28%) and urinary tract (14%). Infections were microbiologically documented in 36% of cases. The most frequently isolated microorganisms were Enterobactriaceae (41%). Antibiotic use restriction was made in 44% of cases including further investigations (16%), antibiotic de-escalation (11%), no antibiotic prescription (9%) and antibiotic discontinuation (8%). In cases where antibiotics have been changed (N=475), the intervention was associated with an overall decrease in the prescription of broad-spectrum antibiotics from 61% to 50% with a decrease in the prescription of third generation cephalosporins from 22% to 15%. CONCLUSIONS: The majority of antibiotic stewardship team's interventions were made in hospitalized patients, university hospitals and medical wards. These interventions resulted in an overall and broad-spectrum antibiotic use reduction.

Neurological manifestations following cured malaria: don't forget post-malaria neurological syndrome.

INTRODUCTION: Cerebral malaria which occurs during the active infection is the most common neurological complication of malaria. Other complications including post-malaria neurological syndrome (PMNS) can rarely occur following complete recovery from the disease. We report a case of post-malaria neurological syndrome in a Tunisian patient. CASE PRESENTATION: A 26-year-old Tunisian man with no past medical history was admitted in 2016 for a muscle weakness of the 4 limbs, seizures, tetraparesis and myoclonus which appeared after he returned from Côte d'Ivoire where he had been treated three weeks ago for Plasmodium falciparum malaria with favorable outcome. Blood smears for malaria were negative. Brain MRI showed multiple hypersignal cerebral lesions. Investigations didn't show any infectious, metabolic, toxic, vascular or tumoral etiology. Thus, the diagnosis of PMNS was considered. The patient was treated with methylprednisolone with favorable outcome. Two years later, he was completely asymptomatic. CONCLUSION: PMNS should be considered in patients with neurological symptoms occurring within two months of cured acute disease in which blood smears for malaria are negative and other etiologies have been ruled out. In most cases, the disease is self-limited while in severe cases corticosteroid therapy should be prescribed with favorable outcome.

Co-infections of human herpesviruses (CMV, HHV-6, HHV-7 and EBV) in non-transplant acute leukemia patients undergoing chemotherapy.

BACKGROUND: Human herpesviruses (HHVs) remain latent after primary infection and can be reactivated in response to immunosuppression and chemotherapy. Little is known about their incidence, potential relationships, risk factors and clinical impact in non-transplant leukemia patients. This study investigated prospectively incidence, risk factors, clinical impact and possible association of HHVs-(1-7) infections in patients with newly diagnosed acute leukemia. METHODS: Study design involved longitudinal sampling before chemotherapy and in different phases of chemotherapy: post-induction, post-remission, and post-salvage during 2016-2018. A total of 734 plasma samples from 95 patients were analyzed by a qualitative, multiplex PCR for HHVs detection and a quantitative real-time PCR was used for cytomegalovirus (CMV) quantification. HHVs-(1-6) IgG and IgM antibodies were tested using immunoassays. Risk factors were analyzed by binary logistic regression and relationships between viruses were analyzed using the Chi-square or Fisher's exact test as appropriate. RESULTS: The overall seroprevalences of HHV-(1-6) IgG were high (> 80%). At least one herpes viral agent was detected in 60 patients (63.3%). CMV was the most commonly detected virus in the different phases of chemotherapy (19.4%), followed by HHV-6 (9.7%), HHV-7 (5.2%) and EBV (2.7%). HSV-1/2 and VZV DNA were not detected. Twenty-seven patients (28.4%) had more than one virus detected in the follow-up, with 23 who were co-infected. CMV/HHV-6 was the most frequent co-infection (69.5%, 16/23). HHV-6 infection (p = 0.008) was identified as a risk factor for CMV infection while salvage treatment (p = 0.04) and CMV infection (p = 0.007) were found to be independent risk factors for HHV-6 infection. CMV co-infection was associated with severe lymphopenia with an absolute lymphocyte count (ALC) (< 500/µL) (p = 0.009), rash (p = 0.011), pneumonia (p = 0.016) and opportunistic infections [bacteremia, p < 0.001 and invasive fungal infection, (p = 0.024)] more frequently than CMV mono-viral infections. CONCLUSIONS: Our data suggest that co-infection with HHVs, especially CMV and HHV-6, may contribute to the development of serious clinical manifestations with profound lymphopenia, pneumonia rash and increased risk for bacterial and fungal co-infections. These findings may suggest the synergistic effect of HHVs associated infection.

Thirty years of Tunisian publication of «case reports¼ in General Surgery (1989-2018).

OBJECTIVE: To describe the bibliometric profile of Tunisian "case report" publications in general surgery over the last thirty years (1989-2018). METHODS: This is a descriptive bibliometric study on "case reports", general surgery, Tunisian affiliation, indexed in the Medline database, between January 1, 1989 and December 31, 2018. The themes of Search articles were defined by referring to their major keywords used for their indexing. RESULTS: During 30 years of study, Medline indexed 188 papers in "General Surgery" type "case reports", signed by 80 authors in first position and 71 authors in last position, belonging to ten academic specialties and 19 professional affiliations. These papers were published by 60 journals, including the Ugandan magazine "Pan African Medical Journal", which published 23% of these "case reports" alone. The number of major indexing keywords was 299 words, mainly "Echinococcosis", "Pancreatic Cancers" and "Echinococcosis of the liver", together accounting for 18.1% of articles. CONCLUSION: The plethora of "case reports" in Tunisian general surgery publications over the last three decades was accompanied by a preferential edition in the journal "Pan Afr Med J" and a thematic focus on hydatid cysts and cancers pancreatic. Hence the importance of strengthening the capacity of Tunisian surgeons in research methodology and scientific medical writing.

Bibliometrics of Tunisian publications on respiratory tract diseases from 2010 to 2014.

AIM: To describe the bibliometric characteristics of Tunisian publications on respiratory tract diseases, during the quinquennium 2010-2014. METHODS: This is a descriptive bibliometric study of respiratory medicine publications, indexed in "Medline", based on their MSDSs. All included articles were written by Tunisian researchers regardless of their position in the list of co-authors. The topics of the publications were explored through their "major" and "generic" keywords. RESULTS: A total of 340 publications was captured in Medline. These articles were co- authored by 218 authors in first position and 163 in last position. They were signed by pulmonologists, in first and last position respectively in 21.5% and 22.4% of articles. The A. Mami Hospital was the major affiliation of the first authors in 19.7% of the publications. These articles were published by 138 journals including "La Tunisie Medicale" in 11.8% of cases. They were "case reports" and written in English respectively in 44.4% and 54.1% of cases. Among 639 major keywords indexing, three were dominant: «Lung Neoplasms¼ (Tumeurs du poumon), «Chronic Obstructive Pulmonary Disease¼ (Broncho-pneumopathie chronique obstructive) and «Tuberculosis, Pulmonary¼ (Tuberculose pulmonaire), in 13.5%, 10.3% and 7.4% of articles respectively. CONCLUSION: Tunisian research on respiratory tract diseases has been thematically concordant with the public health needs. However, it has often been of low-level evidence and published in low-impact factor journals.

Disciplinary and thematic mapping of Maghreb publications in "infectiology". Bibliometric study (Tunisia, 2010-2014).

AIM: To describe the essential bibliometric characteristics of Tunisian publications in "infectiology", during the five-year period 2010-2014. METHODS: This is a descriptive bibliometric study, on the papers of "infectiology", indexed in "«Medline¼", based on their data sheets. Were included all the articles written by Tunisian researchers regardless of their position in the list of co-signers. The themes of the publications were explored through the key words "major" and "generic" in the three chapters of the descriptors: "Bacterial Infections and Mycoses", "Parasitic Diseases", and "Viral Diseases". RESULTS: A total of 846 publications in "Infectiology" were analyzed, of which 66% were written in English and 31% were "case reports". They were signed by 536 authors in first position belonging mainly to microbiology (20.7%), parasitology (20.1%) and virology (7.1%). The 391 co-signatories in last position belonged to 44 specialties, of which pediatrics, internal medicine and infectious diseases respectively occupy the 4th, the 9th and the 10th positions. These publications were edited in 258 journals, mainly "Tunisie Medicale" (9%) and "Pan African Medical Journal" (3.8%). The greatest interest of the Tunisian researchers in infectious diseases have been staphylococcal / tuberculosis infections, chronic viral hepatitis C / human influenza, and echinococcosis / leishmaniasis. CONCLUSION: In Tunisia, infectious diseases research has been relatively prolific and concordant with the population's health needs. Infectious diseases physicians should build their network of care, research and education with biologists, while focusing their research on multicenter and high-level studies.

Smoking behavior among students of health sciences at the university of Monastir (Tunisia).

OBJECTIVE: Measure the prevalence of smoking among students of health sciences Faculties in Monastir (Tunisia) and identify factors associated with smoking behavior. METHODS: A cross-sectional study based on a self-administered questionnaire conducted among students registered in their second, fourth and sixth year at the Faculties of Medicine and Pharmacy in Monastir, in 2013. Smoker was the subject who, at the time of the survey, smoked at least one cigarette per day. Academic difficulties were used to denote any of the following incidents that a student may experience: passing exams at the retake session, revalidating an internship or repeating a school year. A logistic regression analysis was used to identify factors associated with smoking. RESULTS: The number of participants was 634 (285 Medical students and 349 Pharmacy students); they were 170 males and 464 females. The prevalence of smoking was 15%; 95% IC [12.1-17.7]. It was nearly five times higher among male compared to female students (35.3%; 95% IC [28.1-42.5]) vs 7.5%; 95% IC [5.1-9.9]); It was also higher among Pharmacy students than among Medical students (18.9%; 95% IC [14.8-23.0]) vs 10.2%; 95% IC [6.7-13.7]). In the multivariate analysis, the Faculty of Pharmacy (ORa=3.081; 95% IC=[1.7-5.7]), the male sex (ORa=6.929; 95% IC [3.9-12.0]) and the academic difficulties (ORa=1.854; 95% IC [1.02-3.38]) were found to be significantly associated with smoking. CONCLUSION: The level of tobacco use found among Medical and Pharmacy students is alarming. This serious problem has a negative impact on their behavior and can hinder their role model as future health professionals. Greater efforts are needed to develop anti-smoking programs, to educate students and to offer psychological support to deal with school difficulties.

Development of a Balanced Scorecard for the monitoring of hospital performance in the countries of the Greater Maghreb. Systematic Review.

BACKGROUND: Despite the wealth of knowledge on hospital performance, the majority of health facilities in the Maghreb don't have yet a Balanced Scorecard for its measurement. OBJECTIVE: Elaborate, through a systematic review of the biomedical literature, a Balanced Scorecard for hospital performance, consisting of indicators of quality of care, highly recommended and suitable for the professional and managerial contexts of Greater Maghreb health systems. MATERIALS AND METHODS:   This is a "systematic review" study on the topic of indicators to measure hospital performance. A documentary query combining the "Mesh Major Topic" for the two following descriptors "hospitals" and "health quality indicators", has been applied to the "Medline" database over a period of ten years (2004-2013). A focus group composed of clinicians, managers and representatives of civil society, was formed for the selection of a Balanced Scorecard of health facilities in Maghreb, composed of 20 systemic indicators. RESULTS: An in-depth reading of 166 articles included in the study identified 926 quality of care assessment indicators. It is in one of three cases "systemic" indicators applicable to multi-purpose health facilities, and in one case of two, it is"process"indicators focused on a health care activity. Following the work of the focus group, a Balanced Scorecard for hospital performance was developed in a consensual manner. Among these indicators, 18 explored the "care" dimension (average length of stay, bed occupancy rates, turnover beds rates, occupational blood exposure rates, unplanned admission rates, discharge rates, prolonged admissions rates, antibiotic prescription rates, mortality rates, health care-associated infection rates, readmission rates, pressure ulcer rates, patient / staff ratio, staff turnover rates, maintenance of medical records, time sending of the report of hospitalization, staff burnout rates, patients' satisfaction rates), and two indicators were related to training functions and research (number of hours of staff training, publication rates). CONCLUSION: The use, by health care facilities, of this Balanced Scorecard, based on the current data from the literature and adapted to the specific professional context of Greater Maghreb, would be a preliminary condition for the start-up of a strategy to measure and improve hospital performance in the Maghreb countries.

Impact of cognitive absorption on Facebook on students' achievement.

In the great expansion of the social networking activity, young people are the main users whose choices have vast influence. This study uses the flow theory to gauge the impact of Facebook usage on Tunisian students' achievements, with the presumption that the high usage level might reduce students' scholar achievements. The research design suggests that this impact would vary among students with different interests for the university and multitasking capabilities. Facebook usage would develop students' satisfaction with friends and family, which could enhance their academic performance. Analyses from 161 Tunisian students show that Facebook usage does not affect significantly students' academic performance and their satisfaction with the family, whereas it decreases their actual satisfaction with friends. Yet, a high level of satisfaction of the student with his family continues to enhance his academic performance. Overall, though, Facebook usage appears to do not have a significant effect on undergraduate students' academic performance. However, this interdependency is significantly moderated by the student's interest for the university and his multitasking capabilities. Students with multitasking skills and students with initial interest for the university might experience a positive effect of Facebook usage on their studies, as they keep control over their activity and make it a beneficial leisure activity. However, students who do not have these characteristics tend to not have any significant effect. Results help to understand the psychological attitude and consequent behavior of the youths on this platform. Implications, limitations, and further research directions are offered.