The aim of this study was to evaluate roots and root canal morphology of mandibular first and second permanent molars in a Tunisian population using cone-beam computed tomography (CBCT), providing detailed anatomical data to support clinical endodontic practice. This retrospective, descriptive study included 100 CBCT scans from patients referred to the University Dental Clinic of Monastir between January and December 2024. A total of 400 mandibular molars (200 first and 200 second molars) were analyzed. Only teeth with fully developed roots and no prior endodontic treatment were included. Morphological features were assessed in axial, sagittal, and coronal CBCT views. The number of roots, number of canals per root, and canal configurations were recorded based on Vertucci's classification. The presence of radix entomolaris and radix paramolaris was also noted. Statistical analysis was performed using the Chi-square test (p ≤ 0.05). Mandibular first molars exhibited predominantly two-rooted anatomy (98%), with 2% presenting a third distolingual root (radix entomolaris). Second molars displayed more variation, with 5% showing a single root, 4% with three roots, and 1% with four roots. Canal configuration analysis revealed that the mesial root of first molars most commonly exhibited Vertucci Type IV (83.7%), while distal roots showed a predominance of Type I (60.2%). In second molars, mesial roots also frequently presented Type IV (51.1%), whereas distal roots overwhelmingly exhibited Type I (94.4%). Three- and four-rooted molars were more commonly found in second molars. Sex and side differences were not statistically significant (p = 0.579 and p = 0.4, respectively), but root morphology was significantly associated with tooth type (p = 0.003). This CBCT-based study provides the first comprehensive analysis of mandibular molar root and canal morphology in a Tunisian population. The findings confirm substantial anatomical variability, particularly in second molars, and underscore the importance of population-specific data for improving diagnostic accuracy and enhancing the outcomes of endodontic therapy.
International guidelines for the management of coronary artery disease highlight the importance of LDL-C(low density lipoprotein-cholesterol)measurements in assessing cardiovascular risk and monitoring patients. In clinical practice,its direct measurement is complex and expensive. Therefore,calculating LDL-C using several formulas is simpler and less costly. T o evaluate the accuracy of LDL-C estimation formulas of Friedewald,Sampson and Martin/Hopkins compared to its direct measurement in Tunisian patients. A cross-sectional study was conducted including patients following in the Endocrinology Department of Farhat Hached University Hospital of Sousse.Clinical data, metabolic parameters,and lipid profiles including Direct LDL-cholesterol measurement were analyzed. LDL-C was estimated using Friedewald,Martin/Hopkins, and Sampson formulas. A total of 148 patients were included in the study.The male-to-female ratio was 0.51.The mean age of the patients was 58 ± 14.8.The majority of our patients were diabetic (84.5%). Most patients had uncontrolled diabetes (81.8%).Type 2 diabetes was the predominant form (85.6%).The three formulas,Friedewald,Sampson,and Martin/Hopkins provided comparable fasting correlation values with measured LDL-C(r=0.52, 0.55, and 0.47, respectively). One hour after meal intake, LDL-C estimation using the three formulas was similar, showing a strong correlation with measured LDL-C (r > 0.7 for all three formulas). At two hours postprandial, the three formulas showed a moderate correlation with the measured LDL-C value. In this study,all three formulas Friedewald, Sampson, and Martin/Hopkins demonstrated acceptable accuracy in estimating LDL-C compared with direct measurement in Tunisian patients. Overall, these findings support the usefulness of formula-based LDL-C estimation as a practical and cost-effective alternative in routine clinical practice.
Although Algeria, Morocco, and Tunisia have made significant progress in family planning and remain committed to achieving socio-economic and sustainable development goals, recent years have seen a decline in contraceptive use and a rise in unmet contraceptive need. Our review aimed to explore available information and identify gaps in the literature on family planning in Algeria, Morocco, and Tunisia by synthesising published literature on women's contraceptive knowledge, attitudes, and practices in these three countries. Our review followed the framework outlined by Arksey and O'Malley [1] and revised by Levac and colleagues [2]. We conducted a comprehensive search of Medline (Ovid), Embase (Ovid), CINAHL (EBSCOhost), and Web of Science, a supplementary search in Google Scholar, and a hand search of ASJP, CAIRN.info, EMHJ, and La Tunisie Médicale. We included literature in Arabic, English, and French published between January 1990 and September 2024, focusing on women's contraceptive knowledge, attitudes, and practices in the Maghrib. We identified 671 articles from the databases and 70 reports from the supplementary and hand searches. After removing duplicates, conducting initial screens, and retrieving full texts we ultimately included 63 sources in our review. Existing literature revealed that, although contraceptive knowledge has increased over the past decades, gaps in knowledge and misinformation persist. Additionally, fear of side effects and rumours contribute to negative attitudes toward contraception. Through this review, we observed that specific contraceptive methods promoted by early family planning programmes, and the strategies used to promote them, may have had a lasting impact on contraceptive practices, even decades later. Our review highlights the importance of exploring changes in knowledge and attitudes and the factors that influence them, as well as women's lived experiences with contraceptive use and access to services. This knowledge can provide more contextually relevant evidence to inform effective family planning policies and interventions. Like many countries, Algeria, Morocco, and Tunisia have committed to advancing women’s status and health and promoting socio-economic development. A key avenue for achieving these goals is ensuring access to family planning and its essential component, contraception. Algeria, Morocco, and Tunisia have made significant progress in family planning since they introduced national initiatives in the 1960s. However, recent years have seen a decline in contraceptive use and a rise in unmet contraceptive need, reversing earlier trends. To understand this change, we sought to explore the extent of available information and identify gaps in the literature on women’s contraceptive knowledge, attitudes, and practices in these three countries. Using a rigorous methodology, we conducted a review of existing studies to summarise what is known on the topic and ultimately included 63 sources. Our study found that misinformation and lack of contraceptive knowledge persist. This knowledge gap, along with fear of side effects and common rumours, shape women’s attitudes toward contraception. These attitudes in turn affect their choice and use of contraceptives. We also observed that the strategies used in the design of early family planning programmes in these three countries, which promoted specific contraceptive methods, may have had a lasting influence on women’s practices. Overall, this review shows that research on contraception needs to focus more on women’s real-life experiences. By understanding these experiences and women’s perceptions and use of contraceptives, decision-makers can formulate more relevant and effective family planning policies and interventions.
The management of Philadelphia-chromosome positive B-cell acute lymphoblastic leukemia (Ph+ B- ALL) is continuously progressing. However, Tunisian data are limited. The objective was to describe the clinical and prognostic profile as well as the therapeutic outocomes of Ph+ B- ALL. This was a retrospective and descriptive study conducted in the adult clinical hematology department of Aziza Othmana hospital over a period of 12 years. We included patients aged between 18 and 60 years, diagnosed with de novo or secondary Ph+ B- ALL and treated with a combination of chemotherapy and a tyrosine kinase inhibitor (TKI). We collected data on 36 patients with initial central nervous system involvement in only one case. The GRAAPH-2005 protocol was the most used regimen (n=29). Thirty-four patients received TKI: imatinib (n=28) and dasatinib (n=6). After induction, all patients achieved cytological remission. Molecular response was assessed in 21 of whom 52% achieved a molecular response. After consolidation, 17 had molecular response evaluation, with 13 achieving a molecular response. Seven patients underwent allogenic hematopoietic stem cell transplantation, and two underwent autologous stem cell transplantation. In terms of disease progression ,14 patients relapsed with a median time to relapse of 18 months [4-42] after TKI initiation. The 5- year overall survival in our series was 25%. The 5-year relapse free survival and event-free survival were 22% respectively. Our study highlighted the various obstacles encountered in the management of Ph+ B-ALL in Tunisia. Addressing these obstacles could improve therapeutic outcomes.
Imported malaria remains a public health challenge in malaria-free countries. Rapid diagnostic tests (RDTs) are used alongside microscopy, but their performance varies with clinical presentation and epidemiological context. We conducted a retrospective study (2020-2023) at the Parasitology-Mycology Laboratory of Charles Nicolle Hospital, Tunisia, including 25 symptomatic patients and 246 asymptomatic non-permanent resident students from sub-Saharan Africa. Microscopy (thick and thin smears) served as the reference standard. Sensitivity, specificity, positive and negative predictive values (PPV, NPV), and Cohen's kappa (κ) were calculated to assess the performance of the ABON™ PLUS Malaria (Abon biopharm, China) et I-test® (Bacterovir laboratoire) RDTs. Malaria was diagnosed in 35 individuals (13%), comprising 12 symptomatic patients (48%) and 23 asymptomatic patients (9.35%). Plasmodium falciparum was the most common species (95%). In symptomatic subjects, parasitemia ranged from 0.5% to 20%, and both tests demonstrated excellent agreement with the thick blood smear (κ=0.91 for ABON™ Plus; κ=1 for I-test®). In contrast, parasitemia was low (<0.1%) in asymptomatic students. For this group, the ABON™ Plus test showed a sensitivity of 48% and a specificity of 100% (PPV: 100%; NPV: 95%), while the I-test® had a sensitivity of 23.8% and a specificity of 100% (PPV: 100%; NPV: 90%). Consequently, agreement with the reference smear was good for the ABON™ Plus test (κ=0.62) but poor for the I-test® (κ=0.35). Both RDTs performed well in symptomatic cases, but low sensitivity in asymptomatic individuals highlights the importance of microscopy and targeted screening to prevent malaria reintroduction in malaria-free countries.
Multiple myeloma (MM) is a plasma cell malignancy with diverse clinical manifestations. Beyond the classic CRAB features (hypercalcemia, renal insufficiency, anemia, and lytic bone lesions), extramedullary involvement is rare and often life-threatening. This case highlighted atypical and severe pulmonary-pleural manifestations, emphasizing the diagnostic complexity of extramedullary disease. A 67-year-old hypertensive man was admitted with fever, dyspnea, and hemoptysis. He presented with pleural effusion, biologically confirmed alveolar hemorrhage, nephrotic-range proteinuria, and osteolytic lesions. Cytology demonstrated pleural plasmacytic infiltration, and bone marrow aspiration showed 100% plasmacytosis. He was diagnosed with immunoglobulin G-kappa MM with pulmonary and pleural extramedullary disease and achieved partial remission with melphalan-dexamethasone, maintaining clinical improvement for 12 months. This case illustrated rare, severe extramedullary manifestations of MM with renal dysfunction as a key clinical clue. It underscored the importance of early recognition and comprehensive diagnostic evaluation. Prognosis remains poor in aggressive variants despite timely treatment.
Enterococcus species are a common cause of nosocomial bacteremia, affecting patients with severe comorbidities. They are often associated with significant morbidity and mortality. A prognostic, observational, mono-centric and retrospective study was conducted in the intensive burn care unit over 4 years, from January 2020 - December 2023. Burn patients who had at least one episode of Enterococcus spp. bacteremia were included. Out of 1,566 admitted patients, 102 developed at least one Enterococcus bacteremia (an incidence of 7.3%), of which 88 patients were retained for analysis. A total of 104 enterococcal bacteremias were observed. The most common species was E. fæcium (58.7%). Twenty-four percent of the strains were resistant to teicoplanin, and 28.8% were resistant to vancomycin. No resistance to tigecycline or linezolid was noted. The median time to the onset of bacteremia was 7 days, and it was complicated by septic shock in 40.4% of cases. Bacteremia was primitive in 96% of cases and polymicrobial in 78,8% of cases. Median ICU length of stay was 22 days. Mortality was 55.7%. Independent factors associated with mortality due to enterococcal bacteremia were: occurrence of ARDS (acute respiratory distress syndrome), acute renal failure, fungal infection, and Enterococcus resistance to vancomycin. Les bactériémies à entérocoques sont essentiellement nosocomials et sont souvent associées à une lourde morbi-mortalité. Une étude pronostique, observationnelle, monocentrique et rétrospective a été menée dans le service de réanimation des brûlés de Tunisie sur une période de 4 ans (janvier 2020-décembre 2023). Les patients brûlés ayant présenté au moins une bactériémie à Enterococcus Spp ont été inclus. Parmi 1 566 patients admis, 102 ont présenté une bactériémie à Enterococcus Spp (soit une incidence de 7,3%) dont 88 patients ont été retenus. Centquatre bactériémies à entérocoques ont été observées. L’espèce la plus fréquente était E. fæcium (58,7%). Vingtquatre pour cent des souches étaient résistantes à la teicoplanine et 28,8% à la vancomycine. Aucune résistance à la tigécycline ni au linézolide n’a été notée. Le délai médian de survenue de la bactériémie était de 7 jours, et était compliquée d’un état de choc septique dans 40,4% des cas. Il s’agissait d’une bactériémie primitive dans 96% des cas et polymicrobienne dans 78,8% des cas. La durée médiane de séjour de nos patients était de 22 jours. La mortalité était de 55,7%. Les facteurs indépendants associés à la mortalité par bactériémie à entérocoques étaient : la survenue de SDRA, d’une insuffisance rénale aiguë, d’une infection fongique et la résistance de l’entérocoque à la vancomycine.
Male infertility remains a significant global health concern, with hormonal evaluation playing a critical role in understanding spermatogenic dysfunction. While follicle-stimulating hormone (FSH) is widely recognized as a marker of testicular function, the diagnostic value of other hormones such as luteinizing hormone (LH), testosterone, and prolactin remains debated, particularly in context that are specific to a given region. To assess the relationship between serum gonadotropins (FSH, LH), total testosterone, and prolactin and semen quality parameters in Libyan males presenting with primary infertility. This cross-sectional study included 138 males attending a fertility center in East Libya. Semen analysis was performed according to WHO 2010 guidelines. Morning fasting serum levels of FSH, LH, testosterone, and prolactin were measured using standardized immunoassays. Spearman's correlation and multivariate linear regression were used to evaluate associations between hormonal profiles and semen parameters. FSH was significantly associated with sperm concentration (ρ = -0.324, p < .05; β = -1.107, p = .010). LH showed a weak inverse correlation(ρ = -0.175) but lacked predictive value. Testosterone and prolactin were not significantly associated with semen volume, motility, or morphology. Strong internal correlations were observed between progressive motility and morphology (ρ = .569). Elevated FSH levels are a reliable indicator of impaired spermatogenesis in Libyan males with primary infertility. The limited associations of LH, testosterone, and prolactin with semen parameters suggest that FSH should be prioritized in hormonal evaluation. These findings support targeted endocrine testing and underscore the need for region-specific reference ranges and expanded hormonal profiling in future research.
Simulation-based training is recognized as an effective educational strategy for acquiring clinical competencies, particularly among paramedical personnel. However, long-term retention of these skills remains insufficiently studied. The aim was to assess the 12-month retention of technical skills in basic life support (BLS) following initial simulation-based training among paramedical staff. We conducted a 12-month, single-center prospective study including 17 paramedicals working in an emergency department. Participants underwent a theoretical pre-test and an initial practical assessment of BLS skills (chest compressions and bag-valve-mask ventilation), followed by procedural simulation training. Knowledge and technical skills were evaluated immediately post-training (T1) and at 12 months (T2), using a standardized checklist scored out of 15. inclusion of 36 participants, 17 achieved all steps. Mean theoretical scores improved from 7.24±2.15 at baseline to 11.75±5.55 immediately after training (p=0.013), reaching 12.28±3.77 at 12 months. Practical skill scores significantly increased from 4.17±1.34 at baseline to 12.52±1.34 at T1 (p<0.001), with a mean score of 11.14±1.95 at T2, indicating substantial skill retention. Our findings demonstrate sustained retention of both theoretical knowledge and technical skills in BLS at 12 months following simulation-based training among paramedical personnel. These results support the long-term educational value of simulation in enhancing emergency response capabilities within this population. However, a slight decline in performance at 12 months highlights the need for refresher training sessions.
Introduction-Aim: Spondyloarthritis (SpA) is a chronic inflammatory disease associated with an increased cardiovascular (CV) risk that is not fully explained by traditional risk factors. This study aimed to investigate the associations between oxidative stress markers, CV risk profile, and disease activity in a Tunisian cohort of patients with SpA. We conducted a monocentric, cross-sectional study involving 101 patients diagnosed with SpA according to the 2009 ASAS criteria. We collected sociodemographic, clinical, and biological data. Disease activity was assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP). The CV risk profile was evaluated through anthropometric measurements, lipid profile, homocysteine, and the SCORE2 index. Oxidative stress status was determined by measuring glutathione peroxidase (GPx) activity, serum levels of oligo-elements (copper, zinc, selenium). The cohort consisted of 101 patients with a mean age of 40.59 ± 11.41 years. A high prevalence of CV risk factors was observed, including overweight/obesity (57.4%), hypertension (31.7%), atherogenic dyslipidemia (73.3% with elevated non-HDL cholesterol), and hyperhomocysteinemia (58.4%). Patients with active disease (ASDAS-CRP ≥ 2.1) exhibited significantly lower GPx activity (p=0.024). Serum copper levels and the copper/zinc (Cu/Zn) ratio were significantly elevated in patients with systemic inflammation (p < 0.001). A significant negative correlation was found between GPx activity and disease activity scores (BASDAI and ASDAS-CRP). Oxidative stress is closely linked to systemic inflammation and disease activity, with decreased GPx activity and an elevated Cu/Zn ratio emerging as potential biomarkers of inflammatory status.
Gastrointestinal (GI) pain is commonly treated with synthetic spasmolytic drugs, including anticholinergics, smooth muscle relaxants, calcium channel blockers, and opioid receptor modulators. However, these treatments often lead to undesirable side effects. To evaluate the antispasmodic and anti-inflammatory potential of the aqueous extract from the brown seaweed Cystoseira compressa (Comp-AQ). The antispasmodic activity of Comp-AQ was assessed in vitro using rat duodenum contractions induced by acetylcholine (A/Ch) and barium chloride (BaCl₂). The anti-inflammatory activity was evaluated in vivo using the carrageenan-induced paw edema model in rats. A phytochemical screening was performed to identify bioactive compounds, and antioxidant activity was assessed via the DPPH radical scavenging assay. Comp-AQ significantly and dose-dependently inhibited A/Ch- and BaCl₂-induced contractions (82.98 ± 1.5% and 84.06 ± 2.16%, respectively), with a relaxation-response profile similar to alverine, suggesting involvement of voltage-dependent calcium channels. In vivo , Comp-AQ reduced carrageenan-induced paw edema, reaching a maximal inhibition of 71.46% at 100 mg/kg after 3 hours. Phytochemical analysis revealed a high content of marine polyphenols and polysaccharides. The extract exhibited strong antioxidant activity with an IC₅₀ of 30 ± 2.66 µg/mL. The aqueous extract of Cystoseira compressa exhibits antispasmodic, anti-inflammatory, and antioxidant properties. Further structural characterization is needed to definitively identify the responsible bioactive compounds and to confirm the hypothesis of synergistic effects.
Management of febrile neutropenia (FN) depends on several elements. Despite their importance, tunisian data were poor. To describe the clinical, microbiological and therapeutic profile of chemotherapy-induced FN during acute myeloblastic leukemia (AML). This observational cohort study, conducted in hematology department of Aziza Othmana hospital, included all intensive chemotherapy-induced FN episodes observed in patients aged ≥18 years and diagnosed with AML in 2021. Data were retrospectively collected and descriptively analyzed. Among 33 patients, 121 FN episodes were studied. They were observed respectively during induction (52.1%), consolidation (38.8%) or salvage therapy (9.1%) cycles. Episodes were labeled as fever of unknown origin (29.8%), clinically documented infection (51.2%) and microbiologically documented infection (MDI) (19.0%). Clinical infectious sites were skin/soft tissue (44.6%), gastrointestinal tract (27.3%), respiratory tract (27.3%) and otorhinolaryngology tract (5.0%). Gram-positive cocci and Gram-negative bacilli were isolated respectively in 18 and 15 cases, with CoNS and Klebsiella pneumoniae being the commonest. Multidrug-resistant organisms were observed in nine episodes. Extended-spectrum-beta-lactamase was the most common resistance mechanism. An intensive care unit treatment was required in 13 episodes and noted in two episodes. Sepsis was observed in 28.1% of episodes. FN-related mortality was 7.4%, associated with sepsis, pneumonia and MDI. Better supportive care strategies may improve infectious outcome in AML patients undergoing chemotherapy.
Systemic sclerosis is a rare autoimmune disease characterized by microcirculation abnormalities and fibrosis of the skin and/or internal organs. Both genetic and environmental factors are recognized contributors to AID development. Vitamin D, through its receptor, plays a role in immune regulation, and the VDR gene has been identified as a candidate for AID susceptibility. However, studies examining the relationship between VDR polymorphisms and AIDs have yielded conflicting results, often varying by ethnic background. The purpose of this study was to investigate the association of FokI and BsmI polymorphisms of the VDR gene with systemic sclerosis in a Tunisian population. A case-control study was conducted, involving 68 SSc patients and 190 healthy controls. Genotyping of the two polymorphisms was performed using restriction fragment length polymorphism polymerase chain reaction, and data analysis was conducted via SPSS for Windows (version 28.0). Results showed significant differences between SSc patients and controls for both polymorphisms. The BsmI bb genotype (0.28 vs. 0.12; p=0.004) and b allele (0.49 vs. 0.36; p=0.014) were more frequent in SSc patients. Conversely, the FokI Ff (0.54 vs. 0.41; p=0.007) and ff (0.15 vs. 0.06; p=0.008) genotypes, along with the f allele (0.42 vs. 0.26; p<0.001), were more common in the control group. The BsmI polymorphism was associated with increased genetic predisposition to SSc, whereas the FokI polymorphism appeared to confer protection in the studied population.
Toxoplasmosis is a major public health concern, especially in pregnant women, due to the risk of maternal-fetal transmission. Serodiagnosis, although essential, remains challenging for medical biology residents. To evaluate the impact of an educational video on knowledge acquisition and learner perception regarding the serodiagnosis of toxoplasmosis in pregnant women. An observational study was conducted at the Faculty of Medicine of Tunis (May-September 2025), including medical biology residents. Participants completed a pre-test, watched an educational video, and then completed a post-test and a qualitative evaluation. Pre- and post-test means were compared using a paired Student's t-test, and the correlation between knowledge gain and satisfaction was assessed with Pearson's coefficient. Sixty-four residents participated (mean age: 28.5 years; sex ratio = 0.08). Mean scores increased from 12.28 ± 4.0 (pre-test) to 15.41 ± 3.5 (post-test) (p < 0.001), reflecting a significant knowledge gain, with 52% scoring ≥16/20 post-intervention. Overall satisfaction was high: 91% found the video clear and relevant, and 97% would recommend it to colleagues. The correlation between score gain and satisfaction was weak and not significant (r = 0.16; p = 0.26). The educational video is an effective and highly appreciated tool for teaching the serodiagnosis of toxoplasmosis, facilitating the understanding and interpretation of complex serological profiles.
Acetabular fractures represent a major challenge in traumatology due to their significant functional impact. The patient profile, clinical and radiological characteristics, and treatment of this entity are likely to evolve over time. In Tunisia, data on these fractures are limited. To describe the epidemiological, clinical and therapeutic aspects of acetabular fractures in a trauma center. A descriptive retrospective study, spanning 10 years (January 2014-December 2023), included patients treated for acetabular fractures in a trauma center. Demographic, clinical, radiological and therapeutic data were collected. The study included 297 patients. The mean age was 47.8 years. The sex-ratio was 3.8. Road traffic accidents were the predominant mechanism of injury (62%). The most common fractures were posterior wall fractures (21.9%), anterior wall fractures (19.2%) and both-column fractures (9.8%). Hip dislocation was present in 27.3% of cases. Surgical treatment was indicated in 35.4% of cases. An increase in the incidence of acetabular fractures was noted between 2014 and 2023 (23 to 40). Both surgical management and anterior approaches showed a significant increase over the years (p < 0.001). The increase in the incidence of acetabular fractures, the predominance of traffic accidents and the growing use of surgical treatment suggest the importance of developing recommendations on road safety, strengthening the capacity of trauma centers and optimising surgical resources.
Obstructive sleep apnea syndrome (OSAS) in the elderly is common but underdiagnosed pathology due to the accumulated prevalence, atypical symptoms and associated comorbidities. The objective of our study was to determine the clinical and polygraphy characteristics of OSAS in elderly subjects by comparing them to young subjects. Retrospective and comparative study conducted in the pulmonology department of Charles Nicolle Hospital in Tunis, including 110 patients with OSAS. They were divided into two groups: Group 1 including 55 subjects aged 65 and over, and Group 2 including 55 young subjects aged between 18 and 64 years. Clinical, and polygraphy data were collected. The mean age of the elderly subjects was 71 ± 4.6 years, on the other hand the mean age of the young subjects was 50 ± 11 years. Predominance of female sex was in both groups, with less smoking among elders and the absence of alcohol consumption. Physical activity was low in both groups but younger patients were more active (p=0.05). Family obesity was more common among young patients. Comorbidities were more present in the elderly subjects predominantly dyslipidemia (AUC=0.66; p=0.003; CI [0.56-0.76]) followed by high blood pressure (AUC=0.65; p=0.005; CI [0.55-0.75]) and diabetes (AUC=0.62; p=0.021; CI [0.52-0.73]). There was no significant difference between the two groups regarding most of the symptoms but nycturia that was mainly observed among older patients (p=0.017). the AUC was high for the NoSAS score indicating a high discriminant value (0.6; CI [0.51-0.70]). But other screening tools such as the STOP-BANG, Pichot and Epworth scales showed no superiority among both groups with a confidence interval respectively [0.42-0.64], [0.39-0.61]and [0.36-0.58]. Analysis of the polygraphy recording of OSAHS did not differ between the 2 groups, nor did the severity of the pathology (p>0.05). Treatment of OSAHS did not differ between the 2 groups (p>0.05). Hygienic dietary rules were prescribed for all patients. Positive pressure ventilation was prescribed in more than a third of cases in the 2 groups, and mandibular advancement orthosis (MAO) in one young patient. Our study highlights the high prevalence of cardiovascular and metabolic co-morbidities in elderly patients being monitored for OSAHS, in addition to the performance of screening scores in the elderly population especially the NoSAS which justifies the importance of a more targeted early detection in this age group for better management.
Serious games are playing an increasingly important role in medical education. However, their use in pathology remains limited, despite the complexity and high level of rigor of this discipline, which poses a significant challenge for students. To evaluate Patho-Play, a scenario-based serious game for pathology training, by assessing short-term knowledge gains and learner perceptions among third-year medical students. In a prospective single-arm study over two academic years (2023-2025), 28 third-year medical students completed a 45-minute Patho-Play session comprising 12 sequential levels. Knowledge was assessed using a 20-item multiple-choice pre-test and post-test aligned with the internship logbook. Student perceptions were collected via an anonymous questionnaire. In-game performance scores were recorded to measure engagement. Pre-test mean scores increased from 12.25 (SD 1.75) to 17.68 (SD 0.95) out of 20 (p < 0.001; Cohen's d = 3.85). All participants improved by ≥3 points; 50% achieved ≥18/20 post-test. In-game scores (900-1230/1280) reflected task accuracy and hint usage. Student feedback indicated high acceptability: 89% reported added educational value, 86% reported increased engagement, and 79% found the experience immersive. Only 18% perceived enhanced teamwork. Patho-Play demonstrated potential effectiveness for short-term knowledge gains and high learner acceptability. Given the single-arm design and MCQ-based assessment, results should be interpreted cautiously. Future randomized studies are needed to confirm efficacy, evaluate long-term retention, and explore collaborative and adaptive features.
Accurate preoperative evaluation of tracheal stenosis is essential for guiding treatment decisions. Bronchoscopy is considered the "gold standard," but computed tomography (CT) provides promising results. This study aims to compare the accuracy of CT and bronchoscopy in characterizing tracheal stenosis. A descriptive and analytical study conducted over 10 years (2013-2023) included 20 patients with tracheal stenosis confirmed by CT and bronchoscopy. The evaluated parameters were the distance from the stenosis to the glottis, subglottic involvement, stenosis length, stenosis grade (Meyer-Cotton classification), and mucosal condition. The average distance from the stenosis to the glottis was 34 mm in both exams, with significant correlation (r=0.777, p=0.000). The mean stenosis length was 17.6 mm on CT and 15.8 mm on bronchoscopy, also with significant correlation (r=0.689, p=0.001). In two cases, the stenosis was complete and impassable by the bronchoscope. CT accurately predicted the stenosis grade in 70% of cases (r=0.736, p=0.000). Sensitivity for detecting subglottic involvement was 50%, and for granulomas, 25%, with specificities of 94.4% and 93.8%, respectively. CT correlates well with bronchoscopy in measuring the distance to the glottis, stenosis length, and grade but is less effective for detecting subglottic involvement and granulomatous lesions. Combining both techniques is recommended for optimal pre-treatment evaluation of tracheal stenosis.
The prevalence of major LARS and its associated risk factors remains variably reported in the literature. This meta-analysis aimed to assess the pooled prevalence of major LARS and to identify its predictive factors. We conducted a meta-analysis in accordance with PRISMA 2020 and AMSTAR 2 guidelines to identify studies reporting the prevalence of major LARS or its associated risk factors. Subgroup analyses was used to explain heterogeneity. A total of 21 studies comprising 3,730 patients were included. The pooled prevalence of major LARS was 36.8% (95% CI: 30.1%-44.0%), with a 95% prediction interval of 12.0%-71.2%, indicating substantial heterogeneity. Tumor location < 5 cm from the anal margin (p < 0.001) and neoadjuvant radiochemotherapy (p = 0.006) were significantly associated with increased major LARS risk. No significant associations were found with anastomotic leakage, surgical approach, or stoma closure timing. Our meta-analysis showed a prevalence comparable to previously published data. Low tumor location and neoadjuvant radiochemotherapy were identified as two independent risk factors for major LARS. Prospective randomized trials are necessary to improve risk stratification for the development of major LARS.
Chalk talks are a dynamic teaching method that combine real-time visual explanations with active learner engagement, fostering deeper understanding and participation. Despite being a traditional approach, chalk talks remain highly relevant, particularly when integrated with modern pedagogical strategies. This narrative review was conducted to explore implementation strategies that enhance the effectiveness of chalk talks in medical education. A targeted search of PubMed, Scopus, and Google Scholar was performed using keywords such as "chalk talk", "medical education", "PowerPoint integration", "simulation", "bedside teaching", and "case-based learning". Peer-reviewed articles, editorials, and educational reports published in English between 2000 and 2025 were considered. Out of 92 references initially screened, 22 articles were selected for analysis and narrative synthesis. The analysis showed varying emphasis on different teaching methodologies. PowerPoint presentations were discussed in 16 articles, reflecting their central role as a structured digital tool. Simulations were reported in 9 articles. Demonstrations and bedside teaching were discussed in 7 articles each, while case-based learning was reported in 6 articles. Across studies, effective chalk talks were consistently linked with careful planning, clear visual organization, and interactive delivery. Integration with complementary methods enhanced learner engagement, participation, and knowledge retention. Reported limitations included reduced suitability for complex visuals, time constraints, and visibility challenges in large classrooms. Chalk talks remain a versatile and effective teaching method when strategically combined with complementary approaches. Their adaptability allows educators to create interactive, learner-centered environments that strengthen conceptual understanding and promote skill development in medical education.