Overview of the Healthcare Systems of the Maghreb Countries: Issues and Progress

Objectives: To provide an update overview on the current status of healthcare systems in the Maghreb region (Algeria, Morocco, and Tunisia) and to emphasize the progress made in the midst of the challenges facing these countries. Method(s): A descriptive comparative approach of healthcare systems in the three countries, based on data from sources with an established methodology, including descriptive healthcare data from the WHO database. Result(s): The population of the Maghreb will increase from 102 million to 132 million by 2050. The current population is mostly centered in Algeria and Morocco, accounting for 77%. Annual healthcare expenditure per capita is 447.9$, 776.8$ and 854.6$ in Morocco, Tunisia and Algeria, respectively. The average infant mortality rate per 1000 live improved to 10.9 in Tunisia, 16.8 in Morocco and 18.9 in Algeria. Maternal mortality rates have dropped to 43 and 48.5/100 000 births in Tunisia and Algeria, respectively while remaining relatively high in Morocco: 72.6. Number of hospital beds/1000 inhabitants is only 1.1 in Morocco, 1.9 and 2.9 in Algeria and Tunisia, respectively. The number of physicians/1000 people was 0.73 in Morocco, 1.3 in Tunisia and 1.72 in Algeria. This remains considerably low compared to the 3.9/1000 in Europe. The Maghreb countries are currently facing an exodus of physicians, mainly to France, which represents 7.1% and 10.7% of Tunisians and Moroccans, respectively, and more than 24% for Algerians. The Maghreb countries were very early mobilized (governments, ministries of health, civil society) to fight against COVID-19 and have successfully controlled the pandemic, according to pre-established control strategies and the strongly commitment of health professional. Conclusion(s): Despite the considerable progress made, the Maghreb countries still face major challenges. Physicians migration, rising cost of care and endemic infectious disease outbreaks constitute a huge hurdle on the already overburdened and resilient healthcare systems.Copyright © 2023

Assessment of Burden of COVID-19 Infection and the Dynamics in African Union Member States

Objectives: This study assessed the real-world burden of COVID-19 infection in African Union (AU) member states during the first 12 months of the pandemic using selected epidemiological measures. Method(s): Data were sourced from the African CDC and Our World in Data,for time period spanning February 2020 to January 2021. AU member states were classified into low, medium and high burden based on COVID-19 morbidity. We conducted descriptive and inferential analyses of the following epidemiological measures: morbidity and mortality rates (MMRs), case fatality rate (CFR), and case ratios. Result(s): A total of 3.2 million COVID-19 cases were reported during the first 12 months, with 2.6 million recoveries, 536,784 cases remaining active, and 77, 486 deaths. Most countries in AU experienced low burden of COVID-19 (49.1%, n=26) compared to 28.3% (n=15) with medium and 22.6% (n=12) with high burden of the disease. South Africa recorded the highest number of cases (1.31 million) followed by Morocco with 457,625 and Tunisia with 175,065 cases. Correspondently, death tolls for these countries were 36,467, 7,888 and 5,528 deaths, respectively. Of the total COVID-19 tests performed (83.8 million) during the first 12 months, 62.43% were from high burden countries. The least testing occurred in the medium burden (18.42%) countries. The overall CFR of AU was 2.21%. Morbidity rate of 327.52/105 population and mortality rate of 5.96/105 population were recorded during the period with significant (p<0.0001) variations across burden levels and regions. Continental morbidity and mortality rates of 17,359/105 population and 315.933/105 population were recorded with significant correlation (r=0.863, p<0.0001) between them and variations across selected epidemiological measures by COVID-19 burden levels. Conclusion(s): Understanding the true burden of the disease in AU countries is important for establishing the impact of the pandemic in the African continent and for intervention planning and deployment of resources including vaccines.Copyright © 2023

COVID-19 in Tunisia: Mapping and Documenting the Impacts on Those on the Margins

Since the 2011 uprisings, Tunisia has been going through a delicate political transition while the socio-economic context is continuously deteriorating. Our analysis focuses on the exceptional period of the lock down (from the 20th of March 2020 to mid-June 2020). With a large portion of the population deprived of their daily informal jobs, the collateral damages of the coercive measures were immediately visible in Tunisia. By critically engaging with how the coronavirus was politically managed in Tunisia, we propose to map and document plural impacts of the pandemic contextualizing this crisis for specific groups of population and territories: Tunisia's young population from hinterland regions (symptomatic of the 2011 uprising and the territorial division) and illegalized sub-Saharan migrants. By focusing on precarious, invisibilized and marginalized groups, we question processes of politization of socio-economic claims under the circumstantial constraints of the pandemic. Besides, this period (re-)activates new forms of civil society mobilization as well as cooperation through solidarity. In a nutshell, the effects of COVID-19 allow us to observe the transformations in the Tunisian post-revolutionary context through a much broader lens. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Is Democracy Lost?

President Kais Saied's de facto dissolution of parliament in July 2021, abandonment of the constitution, and targeting of the opposition are clear signs that Tunisia is no longer a democracy and has returned to the authoritarian playbook of Arab leaders past and present. I see three main reasons for this abrupt end to Tunisia's decade-old democracy: 1) the failure to accompany political reform with socioeconomic gains for citizens;2) the subsequent rise of populism;and 3) the mistakes of the Islamic party. To move forward in Tunisia and the Arab world more broadly, prodemocratic forces must link freedom, development, and social justice.

The two‐sided paradox of ageism during the COVID‐19 pandemic: The cases of Hungary, Tunisia and Uzbekistan

The consequences of ageing populations around the globe have necessitated policy changes that encourage people to stay in the labour force longer. Finding a job depends on two conditions: the willingness to work and employers' decisions. However, the COVID‐19 pandemic created special circumstances that negatively affected the perception of older workers. Older people were particularly vulnerable to the disease, which justified government action to protect them but at the same time provoked resentment among young people. We conducted an online questionnaire survey in July and August 2020 among the citizens of Hungary, Tunisia and Uzbekistan. Our research aimed to determine the general extent of ageism during the COVID pandemic. Respondents had to possess at least a college degree â€" i.e. be potentially suitable for the position of human resource manager. Despite the wealth of scientific literature and our own experience, the survey results revealed only low levels of ageism because of so‐called social desirability bias. Even so, the participants' responses reflected the characteristics of ageism in relation to their respective countries and living conditions. The small variations in the answers were also enough to provide useful information. Structural equation modelling was used to obtain results.Alternate :Las consecuencias del envejecimiento de la población en todo el mundo han hecho necesarios los cambios políticos que animan a las personas a permanecer más tiempo en la población activa. Encontrar un empleo depende de dos condiciones: la voluntad de trabajar y las decisiones de los empresarios. Sin embargo, la pandemia de COVID‐19 creó circunstancias especiales que afectaron negativamente a la percepción de las personas mayores trabajadoras. Las personas mayores son especialmente vulnerables a la enfermedad, lo que justifica la actuación del gobierno para protegerlas, pero al mismo tiempo provoca el resentimiento de los jóvenes. En julio y agosto de 2020 se realizó una encuesta en línea entre los ciudadanos de Hungría, Túnez y Uzbekistán. Esta investigación pretendía determinar el alcance general de la discriminación por edad durante la pandemia de COVID. Los encuestados debían poseer al menos un título universitario, es decir, ser potencialmente aptos para el puesto de director de recursos humanos. A pesar de la abundante literatura científica y de la propia experiencia de los autores, los resultados de la encuesta sólo revelaron bajos niveles de discriminación por razón de edad debido al llamado sesgo de deseabilidad social. A pesar de ello, las respuestas de los participantes reflejaron las características de la discriminación por razón de edad en relación con sus respectivos países y condiciones de vida. Las pequeñas variaciones en las respuestas también fueron suficientes para proporcionar información útil. Para obtener los resultados se utilizó un modelo de ecuaciones estructurales.Alternate :抄録世界中の人口高齢化の影響により、人々がより長く労働ã‚'続けるã"とã‚'奨励する政策への転換が必要となった。仕事ã‚'å¾—ã‚‹ã"とは、働く意欲と雇用主の判断という二つの条件に依存する。しかし、COVID‐19のパンデミックにより、高齢労働者の認識に悪影響ã‚'及ぼす特別な状況が生み出された。高齢者は特にã"の病気に罹りやすく、政府が高齢者ã‚'保護するための行動ã‚'æ­£å½"化すると同時に、若者のæ€'ã‚Šã‚'引き起ã"した。2020年の7月と8月にハンガリー、チュニジア、ウズベキスタンの市民ã‚'対象にオンラインアンケートã‚'å®Ÿæ–½ã—ãŸã€‚æˆ‘ã€…ã®ç ”ç©¶ã¯ã€COVIDのパンデミックにおける一般的な年齢差別の程度ã‚'決定するã"とã‚'目的とした。回答者は最低で大学の学位ã‚'持っている、すなわち、人事部の管理者に潜在的に適しているã"とã‚'条件とした。文献が多いã"と著者らの経é¨"にもかかわらず、調査結果 ¯ã€ã„わゆる社会的望ましさのバイアスのために年齢差別の程度が低いã"とが明らかになった。それでも回答者の答えは、それぞれの国や生活ç'°å¢ƒã¨ã®é–¢é€£ã§ã€å¹´é½¢å·®åˆ¥ã®ç‰¹å¾´ã‚'åæ˜ ã™ã‚‹ã‚‚ã®ã§ã‚ã£ãŸã€‚å›žç­”ã®å¤šæ§˜æ€§ãŒå°‘ãªã„ã"ã¨ã‚‚ååˆ†ã«æœ‰ç”¨ãªæƒ…å ±ã§ã‚ã£ãŸã€‚åˆ†æžã«ã¯æ§‹é€ æ–¹ç¨‹å¼ãƒ¢ãƒ‡ãƒªãƒ³ã‚°ã‚'使用した。

Anosmia in healthcare workers affected with COVID-19: Prevalence and associated factors

Background: COVID-19 is the most important health problem in the world nowadays. Since the publication of the first cases, the symptoms have become more numerous. Anosmia has been recently recognized as a frequent and relevant symptom for the detection of COVID-19, especially in pauci-symptomatic forms. Objective(s): To determine the prevalence of anosmia in health care workers affected by SARS-COV2 and to identify its associated factors. Method(s): This is a cross-sectional analytical study, carried out over a six-month period, which included all healthcare workers of Farhat Hached Academic Hospital of Sousse, Tunisia, affected by SARS-COV2 and confirmed by polymerase chain reaction or antigen rapid test. Result(s): A total of 474 healthcare workers were enrolled with a mean age of 41.02+/-10.67 years and a sex ratio of 0.2. The gynecology department was the most represented one (13.9%). Nurses were the most affected (31.4%). Hospitalization was required for 16 patients (3.4%). The average time of work was 17.04 +/- 11.6 days. Anosmia persisted for more than 90 days in 35 patients (7.4%). After multiple binary logistic regression, anosmia was statistically associated with female gender (p = 0.001;ORIC95%:2.46 [1.4-4.2]) and blue-collar occupational category (p = 0.002;ORIC95%:3.1 [1.5-6.5]). A significant association was also noted between the presence of anosmia and professional seniority (p = 0.019;OR IC95%: 0.97 [0.95-0.99]) and the duration of work (p = 0.03;OR IC95%: 0.97 [0.95-0.99]). Conclusion(s): Although anosmia seems to be frequent in COVID-19 patients, there is still not enough evidence to affirm that it is a strong predictor of the diagnosis of COVID-19.

Context of SARS-COV- 2 contamination of health care workers in a Tunisian academic hospital

Background: Since the emergence of SARS-CoV- 2 in China, health care workers have been identified as being at risk of contracting Covid-19. Objective(s): To describe the exposure situations of healthcare workers affected by SARS-CoV- 2. Method(s): A questionnaire was established and filled in by healthcare workers practicing at the Sahloul University Hospital of Sousse-Tunisia, who were diagnosed with COVID-19 during the period from September 1, 2020 to December 31, 2020. Data were collected on activity, type of tasks performed, wearing of protective equipment, and existence of possible contacts with cases (professional or extra-professional), in the 2 weeks preceding the date of symptom onset. Result(s): A total of 188/287 infected healthcare workers responded to the questionnaire. The gender and age distribution of the respondents showed a sex ratio of 0.34 and an average age of 41 years. Paramedical staff represented 63% of the participants. Among the infected caregivers, 16 (8.5%) had not worked during the 15 days preceding the symptoms. There were 69 (36.7%) professionals who worked in the Covid sector. The rate of use of a FFP2 mask for the most risky tasks varied greatly according to the sector of practice. Concerning hydro-alcoholic solutions, 58.5% of the workers stated that they had them as often as necessary. Other exposure situations outside of direct patient care were reported by these infected workers: 20.4% reported at least one contact without a mask with one or more caregivers with a confirmed Covid-19 infection, and 32.4% reported contacts with suspected or confirmed cases of Covid-19 infection outside of their professional activity. Conclusion(s): The context of contamination of healthcare workers seems to be essentially professional. The nonuse of protective masks, particularly in non-COVID sectors, as well as the role of contamination between caregivers at their workplace seem to be important determinants of healthcare workers' contamination.

An approach based on process mining to assess the quarantine strategies' effect in reducing the COVID-19 spread

PurposeThe feasibility of process mining combined with simulation techniques in estimating the effectiveness of COVID-19 prevention strategies on infection and mortality trends to determine best practices is assessed in this study. The quarantine event log is built from the CUSP (the COVID-19 US State Policy) database, where the dates of implemented social policies in the USA to respond to the COVID-19 pandemic are documented.Design/methodology/approachCOVID-19 is a highly infectious disease leading to a very high death toll worldwide. In most countries, the governments have resorted to a series of drastic strategies to prevent the outbreak by restricting the activities and movement among their population for a predefined time. Heretofore, different approaches have been published to estimate quarantine strategies and the majority signify the positive effect on managing this pandemic. Notably, the process perspective of COVID-19 datasets is of less concern among researchers. The purpose of this paper is to exploit the process mining techniques to model and analyze the quarantine implementation processes.FindingsThe discovered process model has 51 process variants for 51 cases (states), which indicate the quarantine activities were executed in different orders and periods during the pandemic. The time interval analysis between activities reveals the states with the most extended quarantine periods. These primary process mining insights are applied to define scenarios and variables of an agent-based model. The simulation findings indicate a meaningful relation between enforcing quarantine strategies and a declining trend of infection by 90% in the case of following strict quarantine and mask mandates. It is observed that in the post-quarantine period, the disease repeats its ascending trend unless implementation of different intervention strategies likes vaccination.Originality/valueThis study is the first in introducing process mining techniques in analyzing the COVID-19 quarantine strategies impact. The findings provide valuable insights for policymakers to proper control strategies and the process mining research community in expanding more process-related analysis on this pandemic. Also, the results have broad implications for research in other fields like information science to estimate the impact of quarantine strategies on process patterns in library systems.

Immediate hypersensitivity reaction to COVID-19 vaccines: What's the value of skin tests?

Background: Most of adverse reactions (ARs) caused by COVID-19 vaccines are self-limited and benign, such as localized cutaneous injection-site reactions, fatigue, headache. However, IgE-mediated hypersensitivity reactions (HSR) to COVID-19 vaccines are considered extremely rare. These HSR are either attributed to the vaccine itself or its excipients. Method(s): We carried out a retrospective study including all cases of suspected immediate HSR induced by COVID-19 vaccination and notified to the pharmacovigilance department of Monastir (Tunisia). Skin tests (Prick and intradermal tests (IDR)) to vaccines and their respective excipients were performed. Result(s): Among 339 ARs following COVID-19 vaccination, only 10 cases were related to suspected immediate HSR (7 females/3 males) with an average age of 46 years old. Clinical manifestations were urticaria in 7 cases, anaphylactic reaction grade 3 in 2 cases and grade 2 in one case. The median delay to the onset of symptoms was 3 hours (few seconds to 24 hours). All immediate HSR were secondary to the first dose of vaccine administration. Suspected Covid-19 vaccines were Vaxzevria in 6 cases, Moderna in 2 cases, COMIRNATY and CoronaVac in one case, each of them. Skin tests (Prick test/ IDR10-1/ undiluted IDR) were performed for all patients. Only 2 patients, who presented urticaria and anaphylactic 0.0shock, had a positive result to the culprit vaccine Vaxzevria. Skin test (Prick test/IDR10-1) to the excipient (Polysorbate 80) was negative. Among patients with negative skin tests (n = 8), six underwent vaccination with the same vaccine with antihistaminic premedication, without recurrence of the HSR. In the two remaining patients, culprit vaccines were contraindicated in view of the severity of the reaction Conclusion(s): Hypersensitivity reactions to COVID-19 vaccines are unpredictable and can vary from a localized reaction to life-threatening anaphylaxis. Skin tests can be helpful in the diagnosis of authentic IgE mediated HSR. However, their sensitivity remains to be determined in a large scale population.

How the COVID-19 Pandemic Affected Developing Countries: the Tunisian Investigation

The consequences of COVID-19 vary considerably from country to country and from sector to sector. In this paper, we examine how employment in sectors of Tunisian economy is being affected by the COVID-19 pandemic. For this purpose, we apply the Markov chain approach. This method has the merit to model a system that changes states according to a transition rule that depends only on the current state. We find that the COVID-19 have a negative impact on the employment in industry and in service. Moreover, the agricultural sector benefits most from COVID-19. It is important to plan for economic measures in order to support the resilience of economic establishments, particularly small- and medium-sized enterprises.

Differentiating Acute Infectious and Post-Infectious Cerebellitis: A Tunisian Pediatric Case Series

Background: Acute cerebellitis is the most frequent cause of acute ataxia in children. A clear definition of infectious versus post infectious cerebellitis is lacking in the literature. The outcome is usually favorable although the initial clinical picture varies greatly between patients. The aim of this study was to compare infectious versus post-infectious cerebellitis in terms of clinical features, imaging and outcome. Material(s) and Method(s): We conducted a retrospective descriptive study including patients who were hospitalized at the neuropediatrics department at the national Institute of Neurology of Tunisia, between 2005-2022, having a diagnosis of acute cerebellitis at discharge and a minimal follow-up period of six months. The SARA (Scale for Assessment and Rating of Ataxia) was used to evaluate ataxia at onset and follow-up. Symptoms of ataxia occurring alongside infectious symptoms were considered para-infectious. Result(s): A total of 37 patients were included with a sex ratio of 1,17. Post infectious cerebellitis represented 76% (28 cases). Mean age of onset was 5,79 +/- 3,74 years with no significant difference between groups. A history of infection was found in 84% of patients (31 cases) with a mean time of 7,43 +/- 6,31 days. Mean time of onset from infection was shorter in the para-infectious group (p=0,001) and concomitant fever was more frequently found (p=0,02). Onset was acute in 89% of cases in both groups. Mean SARA score at onset was 9,35 +/- 4,14 with no significant difference between groups. Aetiology was unknown in 51% of cases (19 patients). Two covid-19 related cerebellitis were noted both in the para-infectious group. No difference between groups in terms of imaging or cerebral spinal fluid analysis was noted. There were no sequalae in 78% and 89% of cases in the post-infectious and para-infectious groups respectfully and no difference in terms of outcome or SARA score at follow-up was noted. Conclusion(s): In our cases series, significant differences were noted between the post-infectious and para-infectious cerebellitis subgroups. Mean time of onset from infectious episode was shorter and fever was more frequent in the para-infectious group. A clear definition of para-infectious cerebellitis is needed in order to determine the real proportion of this entity and allow a better management.Copyright © 2022

COVID-19 outbreak and earnings management practice: case of Tunisia

Purpose: This article attempts to investigate the impact of COVID-19 outbreak on the earnings management (EM) for listed Tunisian companies. Design/methodology/approach: The study focuses on both accrual-based and real EM (REM) practices. With panel data, the authors employ the multiple regression approach and the generalized least squares (GLS) estimate method. The sample is made up of 41 listed companies observed from the first half of 2016 to the second half of 2020. Findings: This study finds that, during the pandemic period, Tunisian firms use decreasing income discretionary accruals. Also, with regard to REM, the COVID-19 variable displays a negative response coefficient but of lesser magnitude. Research limitations/implications: This study's findings can help Tunisian authorities, listed companies and market investors to better understand EM practices during a negative shock and to better understand the various internal and external factors influencing the quality of financial reporting. These findings may contribute, also, significant EM implications for scholars interested in other emerging markets. As limitations, the authors point out mainly to the small sample size used in this study and that the authors used a single model, namely the modified Jones model (1995), to measure the accounting EM. Also, the authors used a binary variable as a proxy for the COVID- 19 pandemic. Originality/value: To the best of authors' knowledge, it is the first in Tunisia, if not in Africa, to examine the impact of the COVID-19 pandemic on EM practices. Second, this study builds on previous work by examining both the accrual-based EM and the REM. © 2023, Riadh Garfatta, Mouna Hamza and Imen Zorgati.

Work productivity and activity limitation in healthcare workers after COVID-19 infection

Background: The Covid-19 pandemic has had a significant impact on the physical and psychological health of the people affected. However, this impact has been more significant for health care workers who were on the front line of the management of this health crisis. Objective(s): To evaluate the work productivity and the limitation of activities of healthcare workers in post-COVID- 19. Method(s): A Cross-sectional study was conducted among healthcare workers practicing at the Sahloul University Hospital in Sousse-Tunisia, diagnosed with COVID-19 during a 3-month period. Work productivity and activity limitation were assessed 3 months after infection by the French version of the WPAI questionnaire. Result(s): A total of 188 affected healthcare workers completed the questionnaire (sex ratio = 0.34;mean age = 41 years). Paramedical staff represented 63.1% of respondents. 28.6% worked in the emergency and intensive care units. More than half of the affected workers (52, 4%) had retained physical symptoms 3 months after covid 19 infection. The average percentage of absenteeism was 5.48% and presenteeism was 23.04%. Activity limitation was 26.84%. Work productivity was correlated with age (p = 0.015), presence of pathological history (p = 0.043), and presence of post-covid- 19 physical symptoms (p = 0.007). Conclusion(s): Covid-19 appears to have an impact on work productivity in some healthcare workers.

Post-COVID- 19 syndrome in healthcare workers

Background: COVID-19 is a disease with a varied expression, in terms of its clinical expression, its severity, and its duration. The persistence of symptoms during several weeks or months after the first episode has been reported in several studies. The objective of this survey was to identify the occurrence of post-COVID- 19 symptoms and its determinants in healthcare professionals of Sahloul Academic Hospital in Tunisia. Method(s): A cross-sectional survey was carried out among healthcare workers in Sahloul Academic Hospital in Tunisia for which a diagnosis of COVID-19 was made between September 1, 2020 and December 31, 2020. Data included socio-demographic, professional, and clinical features. Post-COVID symptoms were evaluated 6 months after infection. Result(s): A total of 188/279 affected healthcare workers had participated in our study. The mean age was 41 years and the sex ratio was 0.34. Paramedical staff represented 63.2% of the population. 22.8% were working in the emergency and intensive care units. A previous medical history was reported by 45.2% of patients. The initial symptoms were asthenia (65.4%), headaches (52.9%), and fever (39.4%). Five cases required hospitalisation. Persistent symptoms 6 months after the infection were reported by 67.6% of the staff. The most commonly reported symptoms were asthenia (25%), shortness of breath (24.5%), arthromyalgia (16%), and chest pain (13.3%). The occurrence of post COVID19 symptoms was correlated with female gender (p = 0.018) and initial symptomatic form (p = 0.043). Conclusion(s): The post-COVID- 19 syndrome was common in the population studied. The poly-symptomatic and fluctuating nature of its clinical manifestations raises questions and concerns for patients and clinicians.

Volatility dynamics of the Tunisian stock market before and during the COVID‐19 outbreak: Evidence from the GARCH family models

The aim of this article is to choose the appropriate GARCH model to analyse the volatility dynamics of the Tunisian sectorial stock market indices during the COVID‐19 outbreak period. We explore the optimal conditional heteroscedasticity model with regards to goodness‐of‐fit to these sectorial indices. In particular, it proposes four models (EGARCH, FIGARCH, FIEGARCH and TGARCH) to measure asymmetric and persistence volatility. Our findings point to three interesting results. First, following the COVID‐19 outbreak, volatility is more persistent in all series. Second, the results show that building constructs materials, construction and food and beverage sector return volatilities have an insignificant asymmetric effect while consumer service, financials and distribution, industrials, basic materials and banks sector return volatilities have relatively high positive and significant asymmetric effect compared with those during the pre‐COVID‐19 period. Finally, the findings show that financial services, automobile and parts, insurance and TUNINDEX20 sectors have insignificant leverage effect. Our results can thus be useful to investors when accounting for future volatility and implementing hedging strategies under COVID‐19 crisis.

Place of the Rapid Diagnostic Test in the COVID-19 Management Strategy in Tunisia

Background: The objective of this study was to study the benefit of the rapid antigenic detection of SARS-CoV-2 and to demonstrate the contribution of this technique compared to real-time RT-PCR. Methods: The SARS-CoV-2 nucleocapsid N antigen rapid diagnostic test (Standard Covid-19 Ag Test, SD Biosensor) was performed on 49 patients. Real-time RT-PCR testing was performed only in 12 patients. Results: Nasopharyngeal swabs were taken from subjects whose mean age was 35 years (range 23-68 years) and who presented one of the following symptoms: dry cough (30.61%), chest tightness (28 %), fever (28%), headache (24.48%), asthenia (22.44%) and diarrhea in only 14.28%. The time between the onset of symptoms and the completion of the test ranged from 0 to 2 days. Of all rapid tests performed, 35 (71.42%) were negative and 14 (28.57%) were positive. Of the samples tested, 44 came from different IMKO departments. RT-PCR was performed in 8 patients whose rapid tests were negative and gave a positive result in 2 cases. Conclusion: The detection of SARS-CoV-2 should be evaluated and compared to the standard RT-PCR technique, which often offers significantly better sensitivity. It is necessary to carry out large studies to better understand the issue of potential SARS-CoV-2 recurrence in COVID-19 patients.

The impact of the COVID-19 pandemic on delay in diagnosis and management of lung cancer in developing countries

Introduction: The COVID-19 pandemic has caused an overload within health care structures in Tunisia, impacting negatively on the management of other pathologies. In this study, we estimated the impact of the COVID-19 pandemic on delay in diagnosis and management of lung cancer in a Department of Pulmonology in Tunisia. Method(s): A retrospective study including patients with lung cancer managed between January 2019 and December 2021 in the Pulmonology IV Department of Abderrahmane Mami Hospital. The patients were divided into two groups: Group 1(G1):(n= 59) included patients diagnosed before Covid-19 pandemic (January/December 2019). Group 2 (G2): (n =71) diagnosed during the Covid-19 pandemic (march 2020/December 2021). Result(s): One hundred and thirty male patients were included with an average age of 60.8 years. The mean delay between the onset of symptoms and the first consultation was 43.27 days in G1 versus 39.92 in G2 . The mean delay between first consultation and the histological diagnosis was significantly longer in G2 (34.3 days vs 31.85 days in G1;p = 0.037). The most common histological type in both groups was adenocarcinoma. Sixty point six percent of patients of G2 were diagnosed at metastatic stage (vs 47.5 % in G1 ). The mean delay between histological diagnosis and initiation of specific treatment was significantly longer in G2 (60.34 days vs 41.67 days in G1 ;p = 0.014). Conclusion(s): The study demonstrates the significant impact of COVID-19 on diagnostic and therapeutic delays for lung cancer patients in our department. A specific care pathway needs to be created in order to ensure treatment within the optimal deadlines.

Telepsychiatry in the Arab world: A viewpoint before and during COVID-19

Purpose: Telepsychiatry, a subset of telemedicine, has been increasingly studied to meet the growing demands for psychiatric care. The utility of telepsychiatry is relevant now more than ever as the world endures the COVID-19 global pandemic. This paper describes the prior state and the changes that the COVID-19 outbreak brought to telepsychiatry in a selected group of Arab countries of the Middle East and North Africa (MENA) region. Patients and Methods: We invited twelve early-career psychiatrists from different Arab nations to share information related to telepsychiatry in their respective countries before and during the COVID-19 pandemic. The information was collected using a semi-structured guide. This was complemented by a search for relevant articles in five search engines using terms such as "COVID-19," "telepsychiatry," and "Arab world". Results: Before the pandemic, digital mental health services were provided in several Arab countries, mainly through hotlines and messaging services. The COVID-19 pandemic has marked a major shift in digital psychiatric services in the Arab MENA world, through the transformation of many clinics and some hospitals into digital mental health systems. Many non-governmental organizations also started remote initiatives for psychological support and psychiatric counseling. Three main barriers of patient-related, healthcare-related, and system-related hurdles of using telepsychiatry emanated from the analysis. Conclusion: The use of digital mental health services varies between different Arab countries. Even though some nations have laws that regulate the provision of such services, most struggle with multifactorial barriers. As affordable and attainable solutions cannot only rely on training and recruiting more psychiatrists, telepsychiatry would help meet the exceeding demands in the Arab world, particularly after the COVID-19 outbreak. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

COVID-19 patients : predictive factors for home therapy oxygen

Bakground COVID-19 patients mostly experience a favorable evolution of the disease. However patients without acute respiratory distress syndrome (ARDS) but in need of long term oxygen therapy have received much less attention. Aim(s): To determine the predictive factors of home therapy oxygen after hospital discharge for COVID19 pneumonia. Method(s): We conducted a retrospective study including with laboratory-confirmed COVID-19 infection hospitalized in the pulmonology department of the military hospital of Tunisia. We divided our patients into two groups : the first group (16 patients, 7%) requiring long term oxygen therapy (G1), the second group discharged without oxygen (G2). Result(s): A total of 245 patients were enrolled in the study. The median age was 61 years old. The majority of the population were male (77%). Home therapy oxygen needs were not correlated with the scanner degree impairment upon admission as well as the duration and posology of corticotherapy during hospitalization. It was significatively associated with an increased hospital stay (r=0,314;p=<0,001). Predictive home oxygen therapy factors were patients with extensive fibrotic-like changes on lung CT scan upon admission (r=0.223;p=0.04), heightened procalcitonin (PCT) level (p=0.009). No correlation was found with, intensive care transfer or other biomarkers levels. Independent predictive factors of long term oxygen therapy prescription were increased hospital stay (ORa = 1.092 [1.026-1.164], p = 0.006) and pulmonary fibrosis on lung CT scan upon admission (ORa = 17.405 [2.353-128.721], p = 0.005). Conclusion(s): Increased hospital stay and extensive fibrotic-like on lung CT scan initial should be used to identify patients in need for adjunctive therapy.

Myocarditis following Coronavirus vaccination

Introduction: Myocarditis is an adverse reaction discovered after the marketing of SARS-CoV-2 mRNA vaccines. Nevertheless, this effect is not mentioned as an adverse reaction in the summary of product characteristics of other types of vaccines against this disease. Objective(s): In this work, we aim to present the cases of myocarditis after vaccination against COVID-19 reported to the national Tunisian centre of pharmacovigilance. Method(s): We present the cases of myocarditis reported after the COVID-19 vaccination. All cases are diagnosed according to Brighton's case definition of myocarditis. The vaccines causality assessment was estimated by the French imputability updated method of Begaud et al. Result(s): We included five patients. The sex ratio (M/F) was 4. The mean age was 30 years. All patients had no notable cardiovascular history and did not report any significant past medical history. The onset of symptoms was two days post-vaccination in three patients. The predominant reported symptoms are chest pain and dyspnea in the five cases. Cardiac magnetic resonance imaging (MRI) confirmed the myocarditis diagnosis in four patients (not performed for one patient). All cases were classified as definitive cases according to the Brighton case definition of myocarditis. No patient required hospitalization in a cardiac intensive care unit. All the patients recovered from acute myocarditis within a few days. Conclusion(s): Reported cases of myocarditis post-COVID-19 vaccination in our population are rare, not severe, and have a quick favorable outcome.Copyright © 2022