Doctoral theses at the medical faculty of Tunis from 2015 to 2017: Scientific publication rates and associated factors.

INTRODUCTION: Medical doctoral thesis publication is a way to ensure knowledge dissemination and to increase the scientific research visibility. AIM: To determine thesis-related publication's rate at the Faculty of Medicine of Tunis (FMT), and identify associated factors. METHODS: Cross-sectional retrospective study including medical theses registered at the FMT over the study period (2015-2017). All publications related to the defended thesis were collated by scanning Scopus and Google scholar databases, up to April 2022. Binary logistic regression was performed to assess associated factors to publication. Adjusted Odds Ratios (AOR) were presented with 95% confidence interval. RESULTS: Out of 878 defended theses, 11.8% (n=104) were published. Out of 130 publications in total, 90 (69.2%) interested Scopus-indexed journals with a mean Scimago Journal Rank (SJR) of 0.70. The publication was in English in 73.1% of cases. The median time between the thesis defense and the first scientific publication was 15 months. In multivariable analysis, associated factors to "at least one thesis-related publication" were the resident status of the candidate (AOR=2.35 [1.2-4.7]) and the grade assistant professor of the thesis supervisor (AOR=2.48 [1.1-5.6]). CONCLUSION: Compared to the number of defended theses, the thesis-related publication's rate at the FMT is relatively low. Thus, enhanced support for doctoral students to optimize their engagement in research and to consequently promote scientific publication is highly recommended.

Mercurial hospital waste: management, becoming and recommendations.

INTRODUCTION AND PURPOSE: In hospitals, the use of medical instruments and products containing mercury and the management of mercury waste (MW) collected are regulated in developed countries. In Tunisia, MW end up in landfill and no strategy has so far been adopted. The objective of this study was to quantify MW in two university hospitals in Tunis and to indicate the elimination pathways used and to propose certain recommendations. METHODS: This was a descriptive retrospective study conducted from February to August 2016 and quantifying the MWs from medical products and instruments used by two university hospitals in Tunis during 2015. Semi-structured interviews and focus groups enabled the collection of informations on MW management methods for these products and instruments and their waste and to identify the weaknesses of this management. RESULTS: In 2015, 2,443 mercury thermometers were used by Habib Thameur hospital (HHT) and 7,439 by La Rabta hospital (HLR), releasing 19,764 g of mercury. For dental amalgams, 1,440 g were used at HHT. Their residues (320.4 g) were stored in the original capsules. At HLR, 1,320 g were used but residues, estimated at one-third of the total amount (440g), were discharged into the cuspidor. The total amount released from the amalgams was 380.2g, knowing that half of the volume was mercury. The broken tensiometers (26 at HHT and 113 at HLR) released 183.5g of mercury, the roasted fluorescent lamps (1,627 at HHT and 1,722 at the HLR) 167.4g, Harris Hematoxylin (15 liters at HHT and 18 liters at HLR) 82.5g and used batteries (1,258 at the HHT and 914 at the HLR) 54,3g. In total, with the exception of mercury vapors, the amount of mercury released in 2015 at the two hospitals was approximately 20,632 g. These MW have borrowed the household waste stream (51% of HHT MW and 47% of HLR MW), waste from infectious care activities (47% HHT and 46% of the HLR MW), electrical and electronic waste (1% of HHT and HLR MW), and sewage (1% of HHT MW and 6% of the HLR MW). CONCLUSION: The main supplier of hospital MW is the mercury thermometer (95.8%). The managerial authorities would benefit from the promulgation of a regulatory framework, like the European law of 1998, prohibiting their use on a territorial scale and, by subsidies, replace them with electronic thermometers.

[Is BNP assay useful for the diagnosis of acute dyspnea in emergencies departments?]. / Est-ce que le dosage du brain natriuretic peptide est utile dans le diagnostic de la dyspnée aiguë aux urgences?

BACKGROUND: It would be interesting to the emergency doctor to have at his disposal a helpful diagnostic tool like brain natriuretic peptide (BNP). Such assay is simple, available and reliable. AIMS: To report our experience on the role of BNP in the etiological diagnosis of acute dyspnea (AD) in emergency room (ER) and to assess the cost-effectiveness ratio of such diagnosis strategy. METHODS: A prospective study conducted in the ER of Rabta university teaching hospital of Tunis, from March 1st to June 20th 2010, involving 30 consecutive patients presenting to the emergency for AD. All patients underwent echocardiography in their acute phase and benefited from the dosage of BNP during the first 4 hours. The echocardiography parameters were collected by a single operator who was unaware of the results of the BNP dosage. RESULTS: The mean age of patients was 72.8years with a sex ratio of 1.5. AD was of orthopnea type in 9 cases and stage III NYHA dyspnea in the other patients. Clinical and radiological signs of left heart failure were noted in 30% of cases. Ultrasound data have objectified systolic dysfunction in 4 cases, diastolic in 3 cases and systolic plus diastolic in 10 cases. The BNP levels were below 100 pg/ml in 10 cases with pulmonary origin of the AD. A BNP level between 100 and 400 pg/ml was noted in 3 cases. In our study, the clinical probability of AHF prior to performing the test was estimated at 53% and estimated at 100% after the BNP assay. The BNP assay has reduced the length of stay in the emergency department 4 to 5 days and saved nearly 50% of the cost of care per patient. CONCLUSION: The BNP assay, has allowed us to confirm the AHF all cases. Given the prognostic value and economic benefit of this test we recommend its use in ER of our country.

Incidence of deep venous thrombosis in patients with erysipelas of the leg: prospective study of 30 cases in an emergency department.

The treatment of lower limb erysipelas is based on anti-streptococcal antibiotherapy. The indication of adjuvant anticoagulant therapy is not clear because of the lack of data about the incidence of deep venous thrombosis (DVT) in these patients. We performed a prospective study using a colour Doppler vein exploration combined with ultrasonography within the first 48 h, with evaluation of clinical probability of DVT according to the Wells score to assess the incidence of DVT in patients with erysipelas of the lower limb. Of 30 patients studied, 3 DVT were diagnosed: 2 distal DVT (posterior tibial vein) and 1 proximal DVT (superficial femoral vein) in patients having a clinical score > or = 3. Pulmonary embolism was diagnosed in 2 cases. The incidence of DVTin our study was 10%.DVT should be considered in patients with erysipelas of the lower limb having a high pretest clinical probability.