Impact of the COVID-19 pandemic on breast cancer pathological stage at diagnosis in Tunisian patients.

BACKGROUND: Breast cancer (BC) patients' diagnosis and management was affected by a global reorganization after the Coronavirus disease 2019 (COVID-19). Our study aimed to assess the impact of the pandemic on the pathological stage of newly diagnosed patients with BC compared to pre-pandemic and to identify predictive factors of tumor advanced stage. METHODS: Pathological records of all consecutive newly operated BC patients between March 2020 and December 2021 were reviewed retrospectively. Clinical and pathological prognostic factors of BC were collected and compared between pre-pandemic and pandemic periods. Then, predictive factors of tumor advanced stage were identified. RESULTS: Of the 225 cases included in the analysis, 98.7% were females and 1.3% were males. The median time from first histological diagnosis to first surgical treatment was enlarged by 42 days with a significant difference between the two periods (p = 0.002). Newly diagnosed BC patients during the COVID-19 pandemic were operated at a more advanced stage (54.1% vs 36.2%, p = 0.007), had a greater lymphovascular invasion (p = 0.002), lymph node metastasis (p = 0.015) and are more commonly of IBC NST histological type (p = 0.005). Moreover, multivariate analyses showed that the pandemic period (AOR = 2.28; p = 0.016) and the lympho-vascular invasion (p < 0.001) were independently associated with advanced stage of tumors. CONCLUSION: Our findings proved an increase in alarming rates of advanced stage BC associated with the COVID-19 crisis. These findings support recommendations for a quick restoration of BC screening at full capacity, with adequate prioritization strategies to mitigate harm.

Discordance in receptor status between primary and metastatic breast cancer and overall survival: A single-center analysis.

BACKGROUND: The tumor phenotype may change between primary and metastatic breast cancer. We compared the expression of estrogen receptor (ER), progesterone receptor (PR), and HER2 in a series of primary breast carcinomas (PBC) with their metastatic relapses and analyzed the impact of any changes on survival. MATERIALS AND METHODS: It was a single-center retrospective study, collecting consecutive cases of metastatic breast carcinoma diagnosed in the pathology and medical oncology departments at Habib Bourguiba University Hospital in Sfax, Tunisia. An immunohistochemical study was used to assess ER, PR, and HER2 expression. Overall survival (OS) and post-metastasis survival (PMS) were evaluated using multivariable Cox regression analysis. RESULTS: Our study included 68 patients. ER and PR status changed in 29.4 % and 39.7 % of cases, respectively. Conversions were mainly from positive to negative status (22 % and 23.5 % for ER and PR, respectively). Differences in HER2 status were observed in 19.6 % of cases, with loss of overexpression in 6 patients (10.7 %). Adjuvant trastuzumab therapy and PBC molecular subtype (HR-, HER2+) were associated with HER2 status discordance (p = 0.02 and 0.03, respectively). On multivariable analysis, HR-negative conversion tumors were significantly associated with a worse OS (p = 0.042) and PMS (p < 0.001), compared to HR-concordant positive tumors. CONCLUSION: This study establishes that HR and HER2 status discordance between primary and metastatic breast carcinoma has a prognostic impact on patient outcome. Analyzing these receptors' status in all newly diagnosed cases of metastatic breast carcinoma is strongly recommended and would provide information for changing treatment strategies.

[Knowledge, attitudes and practices of front-line physicians in smoking cessation assistance in Sfax, Tunisia, in 2020]. / Connaissances, attitudes et pratiques des médecins de première ligne en matière d'aide au sevrage tabagique à Sfax (Tunisie), 2020.

Introduction: first-line physicians should play a key role in tobacco control. The purpose of this study is to assess the knowledge and attitudes of front-line physicians as well as their practices for smoking cessation, assess their smoking status and determine the barriers to smoking cessation support. Methods: we conducted a cross-sectional study among a representative sample of front-line physicians practising in the governorate of Sfax in November 2020. Results: a total of 115 first-line physicians were included in the study, with a sex ratio (M/F) of 0.91 and an average age of 43 years (interquartile interval= [34-55 years]). Among the respondents, 26 (22.6%) stated that they were smokers; 98 of the physicians surveyed (85.2%) had not had any postgraduate training in smoking cessation. However, 71 (61.7%) had an idea on nicotine replacement therapy. Regarding attitudes,73 respondents (63.5%) were convinced that physicians were responsible for helping their patients quit smoking. Forty five physicians (39.1%) systematically asked all patients about their smoking habits. The least performed activities of the 5A strategy were the components "help" (14%) and "organize follow-up" (17.4%). Patients' disinterest was considered (53%) to be a significant barrier to smoking cessation assistance by the 61 physicians surveyed. Conclusion: there is a need to evaluate and improve the implementation of the national tobacco control strategy, in particular with regard to the training of front-line physicians.

Epidemiological profile and performance of triage decision-making process of COVID-19 suspected cases in southern Tunisia.

INTRODUCTION: During an epidemic, screening processes can play a crucial role in limiting the spread of the infection. The aim of this study was to describe the epidemiological profile of COVID-19 suspected cases and to evaluate the performance of the triage process in predicting COVID-19 in Southern Tunisia. METHODS: It was a prospective study including all patients consulting to the Hedi Chaker University Hospital departments from March to June 2020. A clinical triage score (CTS) was used to assess the risk of the infection and to refer patients to the appropriate part of the facility accordingly. RESULTS: Overall, 862 patients were enrolled, among whom 505 patients (58.6%) were classified as suspected cases (CTS ≥4). Of these, 46.9% (n = 237) were of mild form. Samples were collected from 215 patients (24.9%), among whom five were COVID-19 positive, representing a positive rate of 2.3%. The in-hospital cumulative incidence rate of COVID-19 was 580/100000 patients. The total daily incidence decreased significantly during the study period (p < 0.001, chi-square for linear trend = 25.6). At a cut-off of four, the CTS had a sensitivity of 40%, a specificity of 32.4%, and negative and positive predictive values of 95.8% and 1.4%, respectively. DISCUSSION: Although the triage process based on the CTS was not as performant as the RT-PCR, it was crucial to interrupt virus spread among hospitalized patients in "COVID-19-free departments".

Prevalence, chronological trends and predictors of treatment outcomes among patients with tuberculosis in Southern Tunisia across two decades (1995-2016).

INTRODUCTION: Tuberculosis (TB) is a communicable disease common worldwide. Influencing factors in TB outcomes include socio-demographics, as well as disease-related and treatment-related factors. This study aimed to analyze the prevalence trends of unsuccessful treatment outcomes in Southern Tunisia during 1995-2016 and to identify their risk factors. METHODS: This was a retrospective study including all notified cases from the tuberculosis center reporting registers in Southern Tunisia between 1995 and 2016. RESULTS: Overall, 2771 TB cases were notified. Unsuccessful treatment outcomes were noted in 196 cases (7%). Unsuccessful treatment outcome was associated with male gender (OR=1.4; p=0.023), elderly status (≥60 years, OR=2.3; p<0.001), joints and bones site (OR=2.2; p=0.002) as well as meningeal involvement (OR=2.4; p=0.023). Lymph node (OR=0.4; p<0.001) and therapy duration ≥6 months (OR=0.003; p<0.001) were statistically associated with lower rate of unsuccessful outcome. Multivariate regression analysis showed that elderly status (AOR=2.3; p<0.001), meningeal involvement (AOR=2.2; p<0.027) as well as bone and joints involvements (AOR=2; p=0.027) were independently associated with unsuccessful outcome. Trends analysis showed that the case-fatality rate significantly increased from 1995 to 2016 (Rho=0.4; p=0.032). CONCLUSIONS: The high prevalence of unsuccessful outcome suggested important inadequacies in the TB program. An effective strategy to improve therapeutic education of patients with TB is therefore urgently needed.

Efficacy of botulinum toxin A for the treatment of hemiparesis in adults with chronic upper limb spasticity.

INTRODUCTION: this study aimed to evaluate the effectiveness of botulinum toxin A (BoNT-A) injection in hemiparetic patients with chronic spasticity in the upper limb resulting from stroke or traumatic brain injury. METHODS: we conducted a retrospective study including 45 patients seen, in our department of Physical Medicine and Rehabilitation, between January 2014 and December 2016. All patients received an injection of BoNT-A (Dysport, 100 U/ml). Affected upper-extremity muscles could be injected as per the investigator's discretion to a maximum total dose of 1000 U. We evaluated muscle tone using Modified Ashworth Scale (MAS). Functional disability was assessed using Modified Frenchay Scale (MFS), Nine Hole Peg Test (NHPT) and Barthel Index (BI). Quality of life (QoL) was assessed using the 36-Item Short Form Health Survey (SF-36). The achievement of treatment goal was assessed by the Goal Attainment Scaling (GAS). RESULTS: patients decreased their MAS score over the first and the third months (p<0.05). MFS showed improvement at 1 month after injection with a median change from baseline of 8 (range: 1-16; p<0.001). The change from baseline ranged from 0 to 5 points for NHPT at 1 month after injection (p< 0.001). This functional improvement was maintained to 3 months. Improvements in Barthel Index was observed at 3 months with a median change from baseline of 5 points (range 0-15; p<0.001). The mean change from baseline of SF-36 score was 4.77 ± 3.39 (p<0.001). The mean GAS T-score was 47.04 ±7.78 (median 50, IQR 7.7), giving a mean (SD) change from baseline of 25.36 ± 8.46 (95% CI 22.82 to 27.90; p <0.001). Binary logistic regression was used to identify the independent factors predicting a favorable functional outcome of Bon-T treatment. It showed that neglect was independent predictive factor treatment failure (p=0.009, OR=3.2) while previous injection of BoNT-A was an independent predictive factors of treatment success (p=0.009, OR=0.3). CONCLUSION: our study showed a good response to BoNT-A injection delivered in the management of chronic upper limb spasticity resulting from stroke or traumatic brain injury. It demonstrated its outcome in improving muscle tone, function and QoL. It also showed that the majority of patients achieved their goal as defined at the start of the treatment, mainly for patients who received previous injection of BoNT-A.

Renal angiomyolipoma: Clinico-pathologic study of 17 cases with emphasis on the epithelioid histology and p53 gene abnormalities.

BACKGROUND: Epithelioid angiomyolipoma (EAML) is a rare potentially malignant variant of renal angiomyolipoma (RAML). This study aims to determine whether RAML clinico-pathologic and molecular features (i.e. p53 gene abnormalities) differ significantly with regards to its histologic variant or to the presence of an epithelioid component within it. METHODS: Consecutively resected RAML were reviewed, tumours comprising at least 80% of epithelioid cells were considered as EAML according to the 2016 World Health Organization classification of tumours of the kidney. P53 gene abnormalities were investigated using both immunohistochemical and molecular analysis. RESULTS: A total of 3 EAML among 17 RAML were identified, accounting for 3.9% of the total AML cases. Fatty aspect on imaging was more observed within tumours devoid of an epithelioid component. EAML showed a higher mitotic rate and a stronger p53 staining, no renal poles involvement and was not treated by nephron sparing surgeries. RAML comprising an epithelioid component demonstrated severer nuclear atypia as well as stronger p53 staining. P53 gene sequencing revealed a missense mutation (c.747G > C) in one classic AML harbouring a strong labelling with p53. CONCLUSIONS: Strong p53 staining in a RAML, even in the absence of gene mutation, may suggest the presence of an epithelioid component or of a truly EAML. To the best of our knowledge, c.747G > C p53 gene mutation is being reported for the first time in a RAML, although its role in AML pathogenesis is still unknown.

Prevalence and risk factors of health care-associated infections in a limited resources country: A cross-sectional study.

BACKGROUND: The aim of this study was to determine the prevalence of health care-associated infections (HAI) in our university hospitals (UH) and to delineate the risk factors associated with HAI. METHODS: We conducted a cross-sectional study in the 2 UH of Sfax, Tunisia on July 2017, including all patients hospitalized for at least 48 hours. It was a 1-day pass per department and a 1-week prevalence survey per UH. RESULTS: Of 752 patients eligible for the study, the total number of HAI was 82, representing an overall prevalence of HAI of 10.9%. Respiratory tract infections were the most prevalent HAI (36.6%). In multivariate analysis, intrinsic risk factors independently associated with HAI were immune-suppression (adjusted odds ratio (AOR) = 2.8; P < .001), diabetes (AOR = 2.2; P = .008), and malnutrition (AOR = 2.2; P = .019). Extrinsic risk factors were endotracheal intubation (AOR = 17; P = .01), transfer to another department (AOR = 9; P = .019), parental feeding (AOR = 7.2; P = .014), tobacco use (AOR = 6.3; P = .004), as well as surgical wound class contaminated or dirty (AOR = 6.3; P = .002), and peripheral venous catheter (AOR = 4.7; P = .006). CONCLUSIONS: Our study highlighted the magnitude of the HAI problem threatening the quality of care in Southern Tunisia. A wise identification of HAI risk factors may help health care workers to ascertain the avoidability of these infections.