Cystic echinococcosis (Echinococcus granulosus sensu lato infection) in Tunisia, a One Health perspective for a future control programme.

The emergence of pandemics with dramatic consequences for human health has obscured endemic diseases that continue to pose a problem for human and animal health in several regions of the world. Among these diseases, cystic echinococcosis, a zoonotic parasitic infection caused by a group of cestodes, Echinococcus granulosus sensu lato, remains a real human and animal health problem in several regions of the world, including the Mediterranean Basin. Despite the implementation of a number of governmental control programmes using several tools (dog treatment, meat inspection, etc.), this infection is still highly prevalent in North Africa. Here we present a review of the epidemiology of cystic echinococcosis in Tunisia, an analysis of the constraints limiting the effectiveness of the control programmes implemented, and finally argue for the use of the One Health framework to improve the effectiveness of future programmes.

Navigating the Factors Affecting Functional Impairment in Spondyloarthritis.

Objectives: This study aimed to assess the predictive factors of functional impairment in spondyloarthritis (SpA) patients assessed with bath ankylosing spondylitis functional index (BASFI) and Lequesne Index (LI). Methods: This retrospective study was conducted at the Rheumatology Department of Mohamed Kassab Institute of Orthopedics, Manubah, Tunisia, and collected data from 2008 to 2019 over a period of 4 months (August to November 2019). Socio-demographic and disease-related data of SpA patients were collected. Disease activity was assessed using the bath ankylosing spondylitis-global score (BASG-s) and the bath ankylosing spondylitis disease activity index (BASDAI). The spinal mobility was evaluated by the bath ankylosing spondylitis metrology index (BASMI). Structural progression was evaluated with the bath ankylosing spondylitis radiologic index (BASRI) and modified stoke ankylosing spondylitis spine score (mSASSS). A multivariate analysis was done to search for predictive factors associated with BASFI and LI. Results: A total of 263 patients were included. The mean age was 38.9 ± 12.7 years and the gender ratio was 2.7. The mean age of onset of SpA was 27.6 ± 10.8 years and disease duration was 11.3 ± 9.5 years. Occupation was significantly associated with BASFI and LI scores. A significant functional impact was notably correlated with a long duration of the disease. The two scores were correlated with a limitation of spinal mobility (BASMI), a greater disease activity (BASDAI and erythrocyte sedimentation rate) and a greater impact of the disease on health status (BASG-s). Significant functional impairment was also correlated with structural impairment (mSASSS, BASRI and sacroiliitis grade). The variables independently related to BASFI were the mSASSS score and the BASDAI. The variables independently related to LI were profession (unemployed subjects had higher scores), the mSASSS score and the BASMI. Conclusion: Occupation, disease activity, mobility and structural progression predicted functional impairment in Tunisian SpA patients.

Docosahexaenoic acid, eicosapentaenoic acid, arachidonic acid, and neural tube defects in Tunisian population.

OBJECTIVE: To determine the effect of maternal status in (plasma and red blood cell) folate, vitamin B12, homocysteine, and vitamin D, as well as their interaction with MTHFR (C677T and A1298C) and MTRR A66G polymorphisms, on maternal plasma docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), and arachidonic acid (ARA) levels and the risk of neural tube defects (NTDs). METHODS: ARA, EPA, and DHA composition was assessed using capillary gas chromatography. RESULTS: ARA and DHA levels were higher in controls than in case mothers for low plasma folate status. For low red blood cell folate status, DHA levels were higher in controls than in case mothers. For high homocysteine levels, ARA and DHA levels were higher in controls than in case mothers. NTD mothers had lower EPA and DHA levels for low vitamin B12 levels. NTD mothers had lower DHA levels for low vitamin D levels. For low plasma folate status, DHA levels in the MTHFR C677T gene and ARA and EPA levels in MTHFR A1298C gene were different among the three genotypes in case mothers. DHA levels in the MTHFR C677T gene were different among the three genotypes in case mothers for both low and high homocysteine levels. For low vitamin B12 levels, ARA and DHA levels were different among the three genotypes of the MTHFR C677T gene in case mothers. In the MTHFR C677T gene, ARA and DHA levels were different among the three genotypes in case mothers for low vitamin D levels. CONCLUSIONS: More advanced research is required to verify a suitable biochemical parameter status in relation to the genotypes in pregnant women.

Critical care ultrasound among Tunisian intensive care residents: A Cross-sectional Survey.

INTRODUCTION: Critical Care ultrasound (CCUS) is more and more used in Tunisian critical care units. An objective assessment of this training has not yet been performed. AIM: To assess the theoretical and practical knowledge about CCUS among Intensive Care Unit (ICU) residents. METHODS: This is a cross-sectional study conducted during the period from January to June 2021. Data were collected using a French language questionnaire distributed on the day of the selection of the residents' posts for the next training period (at the end of June 2021). RESULTS: Out of 75 residents, 37 accepted to answer to the survey (Participation rate =49 %). The majority were female (66.4%). The mean age was 29±12.36 years. Only 5.4% of participants (n=2) had previously received training concerning echocardiography and only 8.1% of the participants have received dedicated training for lung ultrasound (LU). Among the participants, 80.1% of residents (n=30) had never performed a transthoracic echocardiography (TTE). Competence in performing echocardiography was self-assessed quite good and bad by 5.4% and 43.2% of responders respectively. Most of the residents (86%) did not insert before ultrasound-guided central venous catheters. Views known by the participants using TTE were mainly parasternal long axis section (56.8%) and apical 4/5 chambers section (52.8%). All participants (100%) thought that teaching CCU is a necessary part of the training of intensivists. CONCLUSION: Our study highlighted the lack of training of Tunisian ICU residents regarding CCUS learning. Therefore, it is crucial to integrate such learning and training into their training programs.

Evaluation de l'enseignement par les étudiants : Exemple d'un atelier de simulation sur l'ECG.

INTRODUCTION: The electrocardiogram (ECG) is a fundamental tool in medical practice. At the Faculty of Medicine of Tunis (FMT), it is usually taught during a lecture. FMT's Physiology Department has innovated its teaching by introducing simulation workshops. AIM: This study aimed to assess the students' satisfaction with teaching ECG by simulation. METHODS: This was a cross-sectional descriptive study, carried out in April 2018, including 160 students in the first year of the first cycle of medical studies, divided into 10 groups. The students attended an ECG simulation workshop at the FMT media library and then answered a satisfaction form and a self-assessment questionnaire for the workshop. RESULTS: More than 50% of the students answered either satisfied or very satisfied with the duration of the course, the room, the method of the teacher, and their participation in the course of the session. Regarding teaching support, 19.3% of the students were very satisfied with the practice of the ECG on a mannequin versus 25% for the practice on a voluntary student. For the number of students per group, 42.1% of students were dissatisfied. CONCLUSION: This study highlights the weak points of this simulation workshop in order to improve it. Then, it helps to build students' confidence and encourage their adherence to the feedback process. Finally, it shows students' enthusiasm for new teaching methods such as simulation. It would be interesting to generalize this evaluation process for the improvement of medical education and the training of future doctors.

Assessment of knowledge and perceptions of Tunisian psychiatrists regarding telepsychiatry.

INTRODUCTION: Telemedicine has become a fundamental pillar of the evolution of healthcare worldwide. In Tunisia, the challenges of the health system, amplified by the COVID-19 pandemic, have highlighted the urgency to adopt innovative solutions. In this regard, the publication of Presidential Decree No. 318/2022 on April 8 in the Official Journal of the Tunisian Republic represents a significant advance in the regulation of telemedicine. AIM: To assess the knowledge of Tunisian psychiatrists and child psychiatrists regarding telemedicine, its legal framework, and their perceptions of this new medical practice. METHODS: A descriptive cross-sectional study was conducted 8 months after the issuance of the presidential decree. The survey was conducted online through an electronic questionnaire on Google Forms. RESULTS: A total of 68 participants were included in this survey. The median number of professional years was 5±7 years. Among the participants, 82% worked in psychiatry and 18% worked in child psychiatry. The sector of practice was public in 69% and private in 31% of cases. Most of them (62%) did not know about the different telemedicine acts, and 57% of doctors were unaware of the existence of the presidential decree. The majority of doctors (84%) expressed a favorable opinion regarding the adoption of telepsychiatry, regardless of sex (p=0.69), professional status (p=0.512), specialty (p=1), years of experience (p=0.83), and practice sector (p=1). CONCLUSION: Despite a low level of knowledge regarding telemedicine, the study highlights the interest of the participants in integrating telepsychiatry into their clinical practices.

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.

Knowledge of Tunisian physicians about electronic cigarettes.

INTRODUCTION: The electronic cigarette is a new-generation smoking product whose mechanism of use could, in theory, minimize adverse health effects. AIM: Determine the knowledge and perceptions of a sample of Tunisian doctors regarding electronic cigarettes. METHODS: We conducted a descriptive cross-sectional study over a two-month period with a sample of Tunisian doctors. We used an online self-questionnaire on physicians' knowledge and perceptions of e-cigarettes. RESULTS: Data were obtained from 216 physicians. Of the participants, 97.2% were familiar with e-cigarettes, 56.5% reported low knowledge, and 83.4% expressed motivation to learn more about e-cigarettes. Overall, 83.8% of doctors felt that electronic cigarettes are harmful to the user's health. Use of this product would increase the risk of cancer according to 73.1% of participants, the risk of cardiovascular disease according to 68.5% of participants, and the risk of chronic lung disease according to 79.2% of participants. The perception of e-cigarettes as harmful to the user's health was associated with the physicians' medical specialty (p=0.032). The recommendation of e-cigarettes as a smoking cessation tool was negatively correlated with addictology training (p=0.027). CONCLUSIONS: Physicians' knowledge of electronic cigarettes is heterogeneous, reflecting the current lack of information and consensus.

Multivariate investigation of Moringa oleifera morpho-physiological and biochemical traits under various water regimes.

BACKGROUND: The climatic changes crossing the world menace the green life through limitation of water availability. The goal of this study was to determine whether Moringa oleifera Lam. trees cultivated under Tunisian arid climate, retain their tolerance ability to tolerate accentuated environmental stress factors such as drought and salinity. For this reason, the seeds of M. oleifera tree planted in Bouhedma Park (Tunisian arid area), were collected, germinated, and grown in the research area at the National Institute of Research in Rural Engineering, Waters and Forests (INRGREF) of Tunis (Tunisia). The three years aged trees were exposed to four water-holding capacities (25, 50, 75, and 100%) for 60 days to realise this work. RESULTS: Growth change was traduced by the reduction of several biometric parameters and fluorescence (Fv/Fm) under severe water restriction (25 and 50%). Whereas roots presented miraculous development in length face to the decrease of water availability (25 and 50%) in their rhizospheres. The sensitivity to drought-induced membrane damage (Malondialdehyde (MDA) content) and reactive oxygen species (ROS) liberation (hydrogen peroxide (H2O2) content) was highly correlated with ROS antiradical scavenging (ferric reducing antioxidant power (FRAP) and (2, 2'-diphenyl-1-picrylhydrazyle (DPPH)), phenolic components and osmolytes accumulation. The drought stress tolerance of M. oleifera trees was associated with a dramatic stimulation of superoxide dismutase (SOD), catalase (CAT), glutathione reductase (GR), ascorbate peroxidase (APX), and glutathione peroxidase (GPX) activities. CONCLUSION: Based on the several strategies adopted, integrated M. oleifera can grow under drought stress as accentuated adverse environmental condition imposed by climate change.

A Knowledge, attitude and practice (KAP) study on sheep owners regarding fasciolosis in northwest of Tunisia.

Fasciolosis is a worldwide zoonotic snail-borne infection that affects ruminants, it causes high economic losses among livestock. A participatory epidemiological survey was conducted on 204 sheep owners of Sejnane region (District of Bizerte, Northwest Tunisia) to assess their knowledge, attitude and practice regarding fasciolosis. All interviewed sheep owners are aware of this parasitic infection (100%, 204/204), among them, 81% (165/204) reported history of clinical cases in their sheep flocks. According to 33.73% (113/335) of them, sheep get infected by fasciolosis mainly by grazing in wet areas, 79.9% (163/204) of these farmers think that wet climate is the most favourable for the infection. Weight loss (28.40%, 121/426) and submandibular oedema (20.42%, 87/426) are the main clinical signs of fasciolosis cited by interviewed sheep owners and the majority of them (98.53%; 201/204) confirmed that fasciolosis causes significant economic losses. Fasciolosis infection persists in Sejnane region despite the use of antiparasitic drugs, this is due mainly to the fact that animals graze in moist grass (39.88%, 132/331). Treat animals (51.47%, 193/375), prohibit grazing on moist grass (15.20%, 57/357), prohibit grazing on wet soils (14.33%, 53/357) and avoid pastures (10.93%, 41/357) are the main prevention measures cited by interviewed sheep owners. Only 18,14% (37/204) of responders knew that fascioliasis is a zoonotic disease. These results could be considered by animal health decision makers and field veterinarians when implementing control programmes in order to increase breeders' knowledge of fasciolosis.

Functional analysis of MMR gene VUS from potential Lynch syndrome patients.

Lynch syndrome is caused by inactivating variants in DNA mismatch repair genes, namely MLH1, MSH2, MSH6 and PMS2. We have investigated five MLH1 and one MSH2 variants that we have identified in Turkish and Tunisian colorectal cancer patients. These variants comprised two small deletions causing frameshifts resulting in premature stops which could be classified pathogenic (MLH1 p.(His727Profs*57) and MSH2 p.(Thr788Asnfs*11)), but also two missense variants (MLH1 p.(Asn338Ser) and p.(Gly181Ser)) and two small, in-frame deletion variants (p.(Val647-Leu650del) and p.(Lys678_Cys680del)). For such small coding genetic variants, it is unclear if they are inactivating or not. We here provide clinical description of the variant carriers and their families, and we performed biochemical laboratory testing on the variant proteins to test if their stability or their MMR activity are compromised. Subsequently, we compared the results to in-silico predictions on structure and conservation. We demonstrate that neither missense alteration affected function, while both deletion variants caused a dramatic instability of the MLH1 protein, resulting in MMR deficiency. These results were consistent with the structural analyses that were performed. The study shows that knowledge of protein function may provide molecular explanations of results obtained with functional biochemical testing and can thereby, in conjunction with clinical information, elevate the evidential value and facilitate clinical management in affected families.

Catalyzing precision: unraveling the diagnostic conundrum of tunisian familial hypophosphatasia case through integrative clinical and molecular approaches.

Familial Hypophosphatasia presents a complex diagnostic challenge due to its wide-ranging clinical manifestations and genetic heterogeneity. This study aims to elucidate the molecular underpinnings of familial Hypophosphatasia within a Tunisian family harboring a rare c.896 T > C mutation in the ALPL gene, offering insights into genotype-phenotype correlations and potential therapeutic avenues. The study employs a comprehensive approach, integrating biochemical examination, genetic analysis, structural modeling, and functional insights to unravel the impact of this rare mutation. Genetic investigation revealed the presence of the p.Leu299Pro mutation within the ALPL gene in affected family members. This mutation is strategically positioned in proximity to both the catalytic site and the metal-binding domain, suggesting potential functional consequences. Homology modeling techniques were employed to predict the 3D structure of TNSALP, providing insights into the structural context of the mutation. Our findings suggest that the mutation may induce conformational changes in the vicinity of the catalytic site and metal-binding domain, potentially affecting substrate recognition and catalytic efficiency. Molecular dynamics simulations were instrumental in elucidating the dynamic behavior of the tissue-nonspecific alkaline phosphatase isozyme (TNSALP) in the presence of the p.Leu299Pro mutation. The simulations indicated alterations in structural flexibility near the mutation site, with potential ramifications for the enzyme's overall stability and function. These dynamic changes may influence the catalytic efficiency of TNSALP, shedding light on the molecular underpinnings of the observed clinical manifestations within the Tunisian family. The clinical presentation of affected individuals highlighted significant phenotypic heterogeneity, underscoring the complex genotype-phenotype correlations in familial Hypophosphatasia. Variability in age of onset, severity of symptoms, and radiographic features was observed, emphasizing the need for a nuanced understanding of the clinical spectrum associated with the p.Leu299Pro mutation. This study advances our understanding of familial Hypophosphatasia by delineating the molecular consequences of the p.Leu299Pro mutation in the ALPL gene. By integrating genetic, structural, and clinical analyses, we provide insights into disease pathogenesis and lay the groundwork for personalized therapeutic strategies tailored to specific genetic profiles. Our findings underscore the importance of comprehensive genetic and clinical evaluation in guiding precision medicine approaches for familial Hypophosphatasia.

Impact of an educational intervention on patient safety culture among gynecology-obstetrics' healthcare professionals.

BACKGROUND: In recent years, patient safety has begun to receive particular attention and has become a priority all over the world. Patient Safety Culture (PSC) is widely recognized as a key tenet that must be improved in order to enhance patient safety and prevent adverse events. However, in gynecology and obstetrics, despite the criticality of the environment, few studies have focused on improving PSC in these units. This study aimed at assessing the effectiveness of an educational program to improve PSC among health professionals working in the obstetric unit of a Tunisian university hospital. METHODS: We conducted a quasi-experimental study in the obstetric unit of a university hospital in Sousse (Tunisia). All the obstetric unit's professionals were invited to take part in the study (n = 95). The intervention consisted of an educational intervention with workshops and self-learning documents on patient safety and quality of care. The study instrument was the French validated version of the Hospital Survey on Patient Safety Culture. Normality of the data was checked using Kolmogorov-Smirnov test. The comparison of dimensions' scores before and after the intervention was carried out by the chi2 test. The significance level was set at 0.05. RESULTS: In total, 73 participants gave survey feedback in pre-test and 68 in post-test (response rates of 76.8% and 71.6, respectively). Eight dimensions improved significantly between pre- and post-tests. These dimensions were D2 "Frequency of adverse events reported" (from 30.1 to 65.6%, p < 0.001), D3 "Supervisor/Manager expectations and actions promoting patient safety" (from 38.0 to 76.8%, p < 0.001), D4 "Continuous improvement and organizational learning" (from 37.5 to 41.0%, p < 0.01), D5 "Teamwork within units" (from 58.2 to 79.7%, p < 0.01), D6 "Communication openness" (from 40.6 to 70.6%, p < 0.001), and D7 "Non-punitive response to error" (from 21.1 to 42.7%, p < 0.01), D9 "Management support for patient safety" (from 26.4 to 72.8%, p < 0.001), and D10 "Teamwork across units" (from 31.4 to 76.2%, p < 0.001). CONCLUSIONS: Educational intervention, including workshops and self-learning as pedagogical tools can improve PSC. The sustainability of the improvements made depends on the collaboration of all personnel to create and promote a culture of safety. Staff commitment at all levels remains the cornerstone of any continuous improvement in the area of patient safety.

[Retrospective study of 60 cases of uterine rupture at the Maternity Center of Monastir, Tunisia]. / Etude rétrospective sur 60 cas de rupture utérine du centre de maternité de Monastir, Tunisie.

Uterine rupture is a life-threatening obstetric complication. The purpose of this study was to investigate the epidemiological features, maternal and foetal prognosis and different treatment options for uterine rupture in healthy and scarred uteri. We conducted a retrospective monocentric descriptive and analytical study of 60 cases of uterine rupture collected in the Department of Gynaecology-Obstetrics of the Center of Maternity and Neonatology, Monastir, from 2017 to 2021. Patients were classified according to the presence or absence of a uterine scar. Sixty patients were enrolled in the study. The majority of cases of rupture occurred in patients with scarred uterus (n=55). The most common clinical sign was abnormal foetal heart rate. No maternal deaths were recorded and perinatal mortality rate was 11%. Mean BMI, fetal macrosomia rate and mean parity were significantly higher in the healthy uterus group than in the scarred uterus group (p=0.033, 0.018, and 0.013, respectively). The maternal complications studied (post-partum haemorrhage, hysterectomy, blood transfusion, prolonged hospitalisation) were significantly more frequent in patients with unscarred uterine rupture (p=0.039; p=0.032; p=0.009; p=0.025 respectively). Uterine rupture is a life-threatening obstetrical event for the foetus and the mother. Fetal heart rate abnormality is the most common sign associated with uterine rupture. Management is based on conservative treatment in most cases. Patients with scarred uterus have a better prognosis.

[Prevalence and predictors of post-traumatic stress disorder in road traffic accidents]. / Prévalence et facteurs prédicteurs des troubles post-traumatiques chez les accidentés de la voie publique.

Introduction: trauma-related disorders following a road accident have both a health and an economic impact. Methods: we conducted a prospective study to determine the prevalence of these disorders, and to identify risk factors in subjects victims of road accidents and hospitalized in the Department of Orthopedic Surgery and Traumatology of the University Hospital Center of Sfax-Tunisia. Results: a total of sixty-ten subjects were included in this study. The prevalence of acute stress disorder was 37.1% and was associated with female sex, low educational level, previous medical and surgical history, passivity during the accident, severity of injuries and the presence of anxious and depressive symptoms. Post-traumatic stress disorder was observed in 40% of subjects and was associated with urban residential environment, passivity during the accident and anxious and depressive symptoms. Low scores for functional coping strategies and high scores for dysfunctional coping strategies were significantly associated with both disorders. Low educational level, urban residential environment, high levels of anxiety and depression, and denial coping strategy appear to be independent risk factors for acute stress and post-traumatic stress disorder. Conclusion: It is therefore important to determine the profile of people at greater risk of post-traumatic stress disorder, to enable early diagnosis in victims of road accidents.

Predictive Factors for Successful Smoking Cessation in Tunisian Smokers, Sousse-Tunisia: 2015-2020.

OBJECTIVE: Since 2009, the unit of smoking cessation at Sahloul University Hospital - Tunisia was founded. In this context, the objective of our study was to determine the factors associated with smoking cessation in Tunisian smokers. METHODS: It was a descriptive prospective study over five-years-period 2015-2020. We included all patients who willingly came to the anti-smoking consultation of the Sahloul University hospital Sousse Tunisia. Data were collected during the consultation of all patients. We proceeded to a univariate and then multivariable analysis to identify the predictive factors of smoking cessation. RESULTS: Over 5 years, we included 450 patients, mainly males (91.3%). The average age of the consultants was 46 ±15.58 years. The average age of the first cigarette among our patients was 16.83± 4.34 years. The likelihood of smoking cessation was higher among males (p=0.004, OR=9.708), patients attending minimum 3 anti-smoking consultations (p<10-3, OR=5.714), patients benefiting from nicotine replacement therapy (p=0.034, OR=2.123), with high motivation score for smoking cessation (p=0.001, OR=1.980) and with an advanced age of the first cigarette (p<10-3, OR=1.096). However, the likelihood of smoking cessation was lower among coffee and alcohol consumers (p=0.002, OR=0.252) and smokers with less than 5 years smoking habit (p=0.011, OR=0.069). CONCLUSION: Although the decision to stop smoking is a personal one, it requires medical and psychological support as highlighted by our findings. Our study showed that assiduity and medical assistance for tobacco cessation increase smokers' chances of quitting.

Incidence and risk factors of post COVID-19 syndrome: a Tunisian cohort study.

BACKGROUND: It has become increasingly clear that SARS-CoV-2 infection can lead to persistent physical and mental health problems lasting weeks or months, requiring prolonged periods of clinical care and increasing the burden on the healthcare system. This phenomenon, known as post COVID-19 syndrome (PCS), is a relatively new condition, its incidence is still unclear and differs between studies. OBJECTIVES: In this cohort study, we aimed to estimate the incidence of PCS and to identify its risk factors in the Tunisian population. METHODS: This is a prospective cohort study that enrolled patients diagnosed with COVID-19 from the triage unit of the University Hospital of Monastir, Tunisia. between April 2021 and June 2022. Patients were contacted by phone for a follow-up evaluation of PCS 12- weeks after the diagnosis date. RESULTS: A total of 1451 individuals diagnosed with COVID-19 during the study period, responded to the follow-up evaluation after 3 months. The incidence of PCS was found to be 44.03% (95% CI [41.47; 46.58]), with fatigue being the most common symptom (21.5%), followed by cognitive impairment (10.3%), including memory loss and difficulty concentrating. Multivariate analysis revealed that the main associated factors to PCS were female gender (RR = 1.54; CI95% [1.30 - 1.82]), pre-existing comorbidities (RR = 1.30; CI95% [1.10 - 1.52]), duration of acute COVID-19 illness (days) (RR = 1.02; CI95% [1.01 - 1.03]), hospitalization (RR = 1.27; CI95% [1.05 - 1.53]), number of COVID-19 episodes (RR = 1.46; CI 95% [1.28 - 1.67]) and patients having receive two or more doses of vaccine prior to COVID-19 infection (RR = 0.82; CI95% [0.70 - 0.96]). CONCLUSION: Our study allowed to estimate the incidence and identify risk factors of PCS. Recognizing these factors could help to better understand the underlying mechanisms and guide interventions for prevention and management of this condition.

Mating type and microsatellite genotyping indicate that the Tunisian population of Phyllosticta citricarpa is clonal and thrives only asexually.

Citrus black spot (CBS) caused by Phyllosticta citricarpa was reported for the first time in Tunisia in 2019. This was also the first reported occurrence of the disease in a Mediterranean climate. In Tunisia, CBS is mainly found in lemon (Citrus limon) orchards, and is seldom observed on sweet orange (Citrus × sinensis). This recent finding in North Africa raises questions about how the disease has been able to spread under Mediterranean climatic conditions. In this work, 216 Phyllosticta strains collected from lemon orchards in 2021, 2022 and 2023 throughout the country's main citrus-growing provinces were characterised by species morphological and molecular identification, mating type and Simple Sequence Repeats (SSR) microsatellite genotyping (MLG). P. citricarpa was the only species found to be associated with CBS in Tunisia. Although P. citricarpa is a heterothallic fungal species, potentially able to reproduce both sexually and asexually, a single mating type (MAT 1-1-1) idiomorph was found in the population. In addition, three MLGs were observed, across ten microsatellite loci, one of which was massively represented (93 %), indicating a clonal population. The clonality observed suggests a single recent introduction of the pathogen into the country. These findings support the idea that in Tunisia, P. citricarpa only reproduces asexually by pycniospores, with a relatively limited dispersal potential. This is consistent with the absence of pseudothecia on the leaf litter. These results show that CBS is able to thrive under Mediterranean conditions, even in the absence of sexual reproduction. This should be taken into consideration for CBS risk assessment and management.

What constitutes an obstructive ventilatory impairment in a pediatric population? A study design.

INTRODUCTION: There is no clear consensus as to what constitutes an obstructive ventilatory impairment (OVI) in pediatric populations. AIM: To determine the percentage of children/adolescents having an OVI among those addressed for spirometry after taking into account the definitions advanced by some international scholarly societies [British Columbia (BC), British thoracic-society (BTS), Canadian thoracic society (CTS), European respiratory society and American thoracic society (ERS-ATS), global initiative for asthma (GINA), Irish college of general practitioners (ICGP), national asthma council (NAC), national institute of clinical excellence (NICE), Société de pneumologie de langue française, Société pédiatrique de pneumologie et allergologie (SPLF-SP2A), and South African thoracic society (SATS)]. METHODS: This bi-centric cross-sectional study involves two medical structures in Sousse/Tunisia, and will encompass children/adolescents aged 6-18 years. A medical questionnaire will be administered, clinical and anthropometric data will be collected, and the spirometric data will be measured by two spirometers. The following six definitions of OVI will be applied: i) GINA: Forced expiratory volume in 1 second (FEV1) < 80% and a FEV1/forced vital capacity (FVC) ≤ 0.90; ii) ICGP: FEV1/FVC < 0.70; iii) ERS-ATS or BTS or SATS or SPLF-SP2A or NAC: FEV1/FVC z-score < -1.645; iv) NICE: FEV1/FVC < 0.70 or FEV1/FVC z-score < -1.645; v) CTS: FEV1/FVC < 0.80 or a FEV1/FVC z-score < -1.645; and vi) ERS: "FEV1 z-score or FEV1/FVC z-score" < -1.645 or "FEV1 or FEV1/FVC" < 0.80. EXPECTED RESULTS: The percentage of children/adolescents having an OVI will significantly vary between the six definitions. CONCLUSION: The frequency of OVI in a pediatric population will depend on the definition chosen.