Impact of a training intervention on knowledge and practices of health-care workers about reprocessing reusable medical devices in a South-Tunisian University Hospital.

INTRODUCTION: Reprocessing of reusable medical devices (RMD) play an important role in the prevention of health-care associated infections. In this perspective, this study aimed to evaluate the impact of a training program intervention on health-care workers' (HCWs) knowledge and hospital practices about the reprocessing of RMD as a main strategic axis of infection control. METHOD: We led a pre-post quasi-experimental study to evaluate knowledge of HCWs and to assess hospital practices in reprocessing RMD before and after a training intervention from May to November 2020 in Hedi Chaker University Hospital. A self-administrated questionnaire was distributed for each participant to assess knowledge. To evaluate practical skills, an audit grid was used. RESULTS: Overall, 30 participants were included. All HCWs had a fair level of knowledge before training. The knowledge score (KS) has significantly risen from pre to post-training (64/100 vs. 80/100; P<0.001). When stratified by RMD type, a significant increase was noted on post intervention in KS about thermo-sensitive RMD reprocessing (P=0.044) and sterilization of thermo-resistant RMD (P=0.004). As for practice assessment, 5 (62.5%) departments had a fair level of practice. The conformity score (CS) did not significantly change from baseline to post-follow-up (53.5 vs. 56.2; P=0.06). According to the audit sections, we did not find a significant change in the pre- and post-intervention CS in sterilization process (70 vs. 80; P=0.06) and in the cleaning and decontamination steps (66.7 vs. 67; P=0.18). CONCLUSION: As opposed to practical skills, positive impact of the training intervention on HCWs knowledge was noted, which underlined the gap between theory and practice.

Prevalence and predictors of hypertension self-care practice in primary health-care facilities in Southern Tunisia.

BACKGROUND: Unmanaged hypertension (HTN) is usually accompanied with complications leading to disability in older adults. It has been demonstrated that self-care practice is essential for blood pressure control and reduction of HTN complications. OBJECTIVE OF THE STUDY: This study aimed to estimate the level of implementation of HTN self-care practice and to identify their associated factors. STUDY DESIGN: It was a cross-sectional study conducted in Sfax, Southern Tunisia in April 2020. MATERIALS AND METHODS: A total of 6 primary health-care facilities were approached for the study participants according to a single-stage cluster sample, by selecting six grapes randomly. A total of 270 participants were recruited, among whom 250 cases (92.6%) completed the questionnaire. RESULTS: A total of 250 hypertensive patients were included in the study, giving a male to female ratio of 0.77. There were 125 participants (50%) aged over 65years. Overall, 137 cases (54.8%) had a high total self-care practice score. The independent factors of good HTN self-care practice were≥65years [Adjusted odds ratio (AOR)=9.5; P<0.001], university educational level of the participants (AOR=21.2; P<0.001), as well as receiving a health education, by health-care providers (AOR=2.5; P=0.012) and family members (AOR=4.36; P=0.004). Advanced hypertension stage (II and III) (AOR=0.45; P=0.032) and chronic pulmonary diseases, including asthma (AOR=0.42; P=0.027) and chronic obstructive pulmonary diseases (AOR=0.27; P=0.016) were independently associated with poor HTN self-care practice. CONCLUSION: Advanced hypertension stage, pulmonary co-morbidities, education level and lack of self-care education were predictive factors of poor self-care practice. These findings suggested that such factors should be considered when planning HTN self-care education.

The ongoing challenge of Pulmonary Tuberculosis in Southern Tunisia: A review of a 22-year period.

BACKGROUND: Despite the wide use of anti-tuberculosis drugs, pulmonary tuberculosis (PTB) remains one of the most important causes of mortality and morbidity, particularly in developing countries. Therefore, combining clinical and epidemiological approach would be of a great benefit. Our study aimed to describe the epidemiological and clinical specificities of PTB and its recent chronological trends. METHODS: We conducted a retrospective study of all PTB new cases of any age diagnosed between 1995 and 2016 in Southern Tunisia. We applied the direct method of age-standardization using the World Standard Population to compute the age standardized incidence rate (ASIR) and the age standardized mortality rate (ASMR) per 100 000 inhabitants. RESULTS: We recorded 1121 new cases with PTB among 2771 new cases of tuberculosis (40.5%). The ASIR of PTB was 5.3/100 000 inhabitants/year and didn't change over the study period (rho=0.3; P=0.2). Patients with PTB were mainly aged between 15 and 59 years (n=861; 76.8%) and came from urban areas (n=600; 55%). The median duration of treatment was 7.6 months (IQR=[6-8 months]). Successful outcome was notified in 1075 cases (95.9%). Forty-one patients died yielding an ASMR of 0.18/100 000 inhabitants/year. Factors statistically associated with unsuccessful outcome included age≥60 years (OR=5; P<0.001) and shorter treatment duration (6.15 months vs 7.76 months; P<0.001). CONCLUSION: In contrast to the decline in the global PTB incidence reported worldwide and in the neighboring countries, our study revealed no significant change in the PTB rates from 1995 to 2016. Therefore, tools and strategies used to manage PTB should be strengthened by a substantial effort in both basic science and epidemiology to have better incidence curves.

[Active smoking: A major risk factor for human non-communicable diseases in a hospital survey]. / Le tabagisme actif : un facteur de risque majeur des maladies non transmissibles humaines dans une enquête hospitalière.

INTRODUCTION: Tobacco is the main preventable cause of death worldwide. Our study aimed to determine the role of tobacco in the occurrence of non-communicable diseases (NCDs). METHODS: We conducted a retrospective study including all NCDs patients during 2015-2016. NCDs include cardiovascular diseases (CVD), chronic respiratory diseases (CRD), cancers (CS) and diabetes mellitus (DM). RESULTS: We identified 3643 cases of NCDs (43%) among 8478 hospitalizations, all diseases combined. Active smoking was found in 1076 cases (29.5%). Among the NCDs groups, CVD was the most common (65%). Tobacco was significantly associated with CVD (P<0.001), CRD (P=0.002), bronchopulmonary CS (P<0.001), haematological malignancy (P=0.023), and DM (P<0.001). Multivariate analysis performing binary logistic regression revealed that tobacco was an independent factor associated with CVD (OR=2.6, P<0.001), CRD (OR=1.5, P<0.001), bronchopulmonary CS (OR=1.8, P=0.013) and DM (OR=3.6, P<0.001). CONCLUSION: Active smoking was a major risk factor in the occurrence of NCDs. Thus, smoking cessation represents the cornerstone for preventing the spread of these diseases, especially in countries with limited resources.

Implication of the Galectin-3 in colorectal cancer development (about 325 Tunisian patients).

Galectin-3 is a specific soluble lectin of the beta-galactoside family. It plays an important role in cell adherence, proliferation, and differentiation. It has also been shown that galectin-3 expression correlates with tumor progression in several types of cancers. We investigated the involvement of galectin-3 in colorectal cancer development. We performed a comparative immunohistochemical analysis of galectin-3 expression in term of intensity and distribution in normal mucosa, in primary tumor and in metastasis from 200 patients with colorectal cancer selected among 325 cases. We also compared the galectin-3 staining according to the histological subtype (mucinous vs non mucinous), tumoral differentiation and stage of tumor. We showed a strong and diffuse positive staining of galectin-3 in both adjacent and distanced normal mucosa, in well differentiated adenocarcinoma and in metastasis. However, we note a progressive decrease of galectin-3 staining according to the decreasing degree of tumoral differentiation. We also observed a loss of this protein in adenocarcinoma with mucinous component < 50%, where the positive staining was limited only to the well differentiated areas of tumor. These data suggest that galectin-3 play an important role in colorectal cancer progression concerning the non mucinous carcinoma and can be used as a prognostic factor to predict poor outcome of patients. In mucinous subtype, galectin-3 might be implicated in one or many step of its genesis perhaps through the control of cellular adhesion and interaction with mucin produced. Adenocarcinoma with mucinous component <50% would be integrate to mucinous carcinoma, not to non mucinous ones. These investigations could open perspectives for therapeutic means targeted to improve the prognosis of this neoplasm.

[Esophageal leiomyomatosis revealing an Alport syndrome]. / Léiomyomatose oesophagienne révélatrice d'un syndrome d'Alport.

Alport syndrome is a rare progressive hematuric nephropathy associated with sensorineural deafness. Leiomyomatosis associated with Alport syndrome is quite rare. We report a particular case of Alport syndrome which was diagnosed in the setting of an oesophageal leiomyomatosis. Alport syndrome and leiomyomatosis are caused by mutation of the genes encoding for the alpha chain of type IV collagen. In view of the important clinical and genetic implications, renal function and urinary status should be controlled in any patient with oesophageal leiomyomatosis.

Autosomal dominant Alport's syndrome: study of a large Tunisian family.

Alport's syndrome is a hereditary nephritis that may lead to end-stage renal disease (ESRD) in early adult life. It is a clinically and genetically heterogeneous nephropathy. Alport's syndrome is often associated with sensorineural deafness and/or ocular abnormalities. In contrast with the well-known X-linked phenotype, very little is known about the autosomal dominant form caused by mutations in COL4A3 and COL4A4 in the chromosome region 2q35-q37. We describe a Tunisian family with autosomal dominant Alport's syndrome in which males and females were equally affected. Two members reached ESRD at age 40 and 53 years, respectively. Three members experienced isolated microhematuria and one member experienced sensorineural deafness. No eye abnormalities were observed. Immunohistochemical studies showed a normal distribution of the alpha5 (type IV collagen) chain in the epidermal basement membrane. Genetic analysis demonstrated that a common haplotype co-segregated with the disease in the heterozygous state in all affected patients, thereby, confirming an autosomal dominant mode of inheritance. The same haplotype was observed in two asymptomatic children. We conclude that autosomal dominant Alport's syndrome, follows a rare mode of inheritance and exhibits a milder phenotype than usually observed in classic X-linked Alport's syndrome. The frequency of this mode of inheritance should be confirmed by a larger study.

[Immunohistochemistry contribution in Alport syndrome diagnosis]. / Apport de l'immunohistochimie dans le diagnostic du syndrome d'Alport.

UNLABELLED: Alport syndrome (AS) is an hereditary disease characterised by the association of progressive hematuria nephritis. The diagnosis is based on clinical genetic and ultrastructural findings. Nowadays, immunohistochemical technique is of great interest. It enables us to analyze the distribution of the different chains of the type IV collagen in renal basement membrane (RBM) and epidermal basement membrane (EBM) which appeared to be abnormal in 70% of cases. METHODS: We report a prospective study of five families affected with AS. Six patients were investigated by immunohistochemical studies of kidney (3 cases) and skin (6 cases) frozen specimens. Monoclonal antibodies recognizing the collagenous domain of alpha1 (MAB1), alpha3 (MAB3) and alpha5 (MAB5) chains of type IV collagen were used. Two methods were performed: direct immunofluorescence and immunohistochemical (ultravision) analysis. RESULTS: The different chains distribution of type IV collagen in the EBM and RBM was normal in four cases (4 men), abnormal in two patients (1 man and woman). Based on the clinical, genetical and immunohistochemical findings we established three transmission modes: autosomal recessive in two families, dominant X linked in two other familiales, and autosomal dominant in one family. CONCLUSION: Immunohistochemical studies is a simple technique of an easy interpretation accomplished on kidney frozen specimen, or even on a simple cutaneous biopsy. It could be very useful for the diagnosis and enables us in addition to determine the mode of transmission of AS.

Polysaccharide storage myopathy--case report and literature review.

Polysaccharide myopathy is a rare form of storage muscular disorder. The clinical picture of this particular form of myopathy is unspecific. We report a 62-year-old woman with late-onset progressive weakness and wasting, affecting proximal muscles of the four limbs and the girdles. No myalgia, dysphagia nor symptoms of cardiac failure were observed. Muscle biopsy revealed a vacuolar myopathy with accumulation of amylopectin-like polysaccharide. This material was strongly PAS-positive and diastase-resistant. At electron microscopy, the deposits were composed of non-membrane-bound filamentous and granular material surrounded by numerous mitochondria. No enzyme deficiency was found. Clinical presentation of our patient was similar to the 16 cases reported in the literature. She did not have myocardiopathy and her survival is much longer. Hypothetic mechanisms of polysaccharide accumulation are reviewed.

[Hemolytic-uremic syndrome secondary to scorpion envenomation (apropos of 2 cases)]. / Le syndrome hémolytique et urémique (SHU) secondaire à une envenimation scorpionique (à propos de deux cas).

HUS was recently described following scorpion sting. We report 2 cases of HUS in the intensive care unit of a university hospital. Two children aged respectively 10 months and 1 year were admitted in the ICU after severe scorpion envenomation (with coma and pulmonary oedema) having required dobutamine and mechanical ventilation. Evolution was marked with acute anaemia without bleeding requiring blood transfusion, acute renal failure, low platelets and signs of haemolysis. Our experience and the previously reported case suggest that scorpion sting could be added to the list of causes of the HUS.

[Lupic spinal cord diseases and antiphospholipid antibodies]. / Myélopathies lupiques et anticorps anti-phospholipides: 2 cas.

Central nervous system involvement in systemic lupus erythematosus (SLE) is frequent and severe, however, myelopathy is rarely reported (0.8 p. 100 of SLE cases). We describe two SLE-young women. They were 21 and 37 year old, presented with acute paraplegia. CSF study showed pleocytosis and moderately elevated protein. Antinuclear, anti-DNA and anticardiolipin were positive. High dose steroids therapy induced marked improvement. The pathogenesis of myelopathy in SLE remains unclear. Anti-phospholipid antibodies may cause thrombosis and ischemic myelopathy. However, auto-antibodies directed against central nervous system constituents may be involved.

[Renal needle biopsy in children. Technical aspects and results]. / Ponction biopsie rénale de l'enfant. Aspecs techniques et résultats.

Renal needle biopsy is still irreplaceable in children. The objectives of this retrospective study were to specify the technical aspects and the main nephropathies encountered. 152 children under the age of 16 years (13 +/- 3), 79 boys and 73 girls, underwent renal biopsy. The biopsy was performed after radiographic detection in 71 cases, and under continuous ultrasound guidance in 81 cases. The comparative study of these 2 techniques revealed the superiority of continuous ultrasound guidance, allowing biopsy of an essentially cortical fragment, rich in glomeruli with a limited number of punctures. Histological examination showed a predominance of glomerular nephropathy with, especially, visually normal kidney and membranoproliferative glomerulonephritis. These data encourage us to perform ultrasound-guided RNB in children and to eradicate sites of infection, particularly involving the upper respiratory tract.

[Septic thrombosis of the cavernous sinus complicating malignant staphylococcal infection of the face]. / La thrombose septique des sinus caverneux compliquant la staphylococcie maligne de la face.

Septic thrombosis of the cavernous sinuses most commonly follows staphylococcal infections of the middle third of the face. Orbital symptoms are constant. We report six cases diagnosed only by CT. At present, MR imaging is the diagnostic procedure of choice. Its findings are thought to reflect the septic nature of the thrombosis.