Long-term therapeutic outcomes of facial arteriovenous malformations: A retrospective bi-centric study of 30 cases.

INTRODUCTION: Among vascular malformations, arteriovenous malformations (AVM) are potentially the most invasive and destructive especially when located on the face. Their management is still subject to controversy and yet no consensus exists. Our aim was to report long-term therapeutic outcomes for patients with facial AVM managed either by embolization alone or by resection with/without preoperative embolization. MATERIAL AND METHODS: A bi-centric retrospective study was carried out covering the period from 2001 to 2018 including 30 patients with a facial AVM. Outcomes were categorized as follows: with 1=controlled disease, 2=improved disease (residual, no expansion), 3=persistent or stable disease (neither improved nor worsened), and 4=recurrent or worsened disease. RESULTS: The initial treatment modality was embolization (n=5, 16.7%), surgical resection (n=16, 53.3%), and surgical resection after embolization (n=9, 30%). The follow-up period ranged from 12 to 216 months with a median of 54.9 months. Taking all treatment modalities together, disease control was achieved in 60% of the cases. Disease control was achieved in 77.8% of the cases after embolization followed by surgery, in 68.7% after surgery alone and in none of the cases after embolization alone. CONCLUSIONS: According to our results, optimal treatment is based on a combination of embolization followed by a well-conducted surgical treatment.

Cognitive emotion regulation questionnaire: Psychometric properties of the Tunisian version.

OBJECTIVES: This study investigated the psychometric properties of the Cognitive Emotion Regulation Questionnaire in a Tunisian Arabic-Speaking population. METHOD: The CERQ original version was translated and back-translated and then administrated to 360 participants. Afterwards, using the explanatory and confirmatory factor analysis, we studied the latent factor structure for CERQ. The internal consistency of the subscales was assessed by Cronbach's alfa coefficients, and the test-retest and interscale reliability were assessed with Pearson correlations. The criterion validity was also examined using correlations between the CERQ subscales and both the Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) scales at first evaluation and at a one year follow-up. RESULTS: The Tunisian version was quite satisfactory with the nine-factor structure, as in the original CERQ. Moreover, all validity and reliability measures were comparable to the original CERQ. CONCLUSION: The present study is the first work devoted to a Tunisian adaptation of the CERQ. Our findings highlight that the Tunisian version is both reliable and valid for the measurement of cognitive emotion regulation strategies.

[Smoking attitudes and behavior of the hospital staff Sahloul (Sousse, Tunisia)]. / Attitudes et comportements tabagiques du personnel de l'hôpital Sahloul (Sousse, Tunisie).

BACKGROUND: Smoking is a major public health problem. Legislation banning smoking in public institutions exists but is not strictly enforced, particularly in health facilities. Therefore health workers have a crucial role to play in the control of smoking on account of their contact with patients and their credibility and moral authority in health matters. They can help patients by their advice and by abstaining from smoking in the hospital themselves. The aim of our study was to determine the prevalence of smoking among medical staff at the University Hospital of Sahloul in Sousse and their attitudes and behaviour with regard to smoking. METHODS: The data came from a descriptive cross-sectional study conducted during the year 2013-2014 using a self-administered questionnaire and included the health personnel of all services and laboratories of the University Hospital of Sahloul in Sousse. RESULTS: The participation rate was 71% (768/1081). Our study population was predominantly female (51%) with a mean age of 37.8 (±11.3) years. The overall prevalence of smoking was 21%. It was significantly higher among men (38.8%) than women (4.6%). This prevalence was higher among physicians/pharmacists (29.5%). More than half the smokers (58%) started smoking between the age of 19 and 25 years. Nicotine dependence was moderate among 27.4% and strong among 18.3% of smokers. The average dependence score was 4.1±2.4 [0-9] with a median of 4.0. Two-thirds of smokers (66.5%) reported smoking in the workplace. CONCLUSION: Confronted with the problem of tobacco, health institutions should find solutions for the prevention of smoking in hospitals. It seems necessary to train and involve hospital staff in anti-tobacco measures and to help smokers to quit in order to make our hospital a tobacco smoke free space.

[Smoking behavior, knowledge, and attitudes towards anti-smoking regulations of nursing students in Sousse, Tunisia]. / Comportement tabagique, connaissances et attitudes relatives à la lutte anti-tabac des étudiants infirmiers de la ville de Sousse, Tunisie.

BACKGROUND: Smoking prevalence has reached high rates among health professionals. Our study aimed to assess smoking behavior, knowledge and attitudes towards anti-smoking regulations of nursing students. METHODS: In 2013, we conducted a cross-sectional study among nursing students enrolled in private and state nursing institutions of Sousse (Tunisia). RESULTS: In our study, 440 students were selected. The mean age was 22 ± 2 years. The sex ratio was 0.65. The prevalence of smoking was 20.6%. It was significantly higher in men than women (50% vs 4.5%, P < 10(-3)). Strong dependency was noted in 9%. One-third of smokers stated they wanted to quit smoking. Prohibiting the sale of cigarettes to minors and smoking in enclosed public places were the two most mentioned anti-smoking regulations. CONCLUSION: Our rate was lower than those reported in the literature. This result should encourage policymakers to continue actions and ensure sustainability.

[Smoker's clinical characteristics at a tobacco cessation consultation (Sousse university hospital, Tunisia)]. / Profil clinique des fumeurs à la consultation d'aide au sevrage tabagique (Centre hospitalier universitaire de Sousse, Tunisie).

BACKGROUND: Smoking cessation intervention is among the most vital elements of the prevention of tobacco smoking. Our study aimed to describe the clinical profile of patients attending our smoking cessation unit. METHODS: We conducted a cross-sectional study from December 2009 to June 2012. The patients were recruited in the Tobacco cessation unit of Sahloul Hospital (Sousse, Tunisia). The data were collected from the consultants' records. RESULTS: A total of 279 patients attended. They were mostly men (92.8 %). The mean age was 41.7 ± 13.4 years. Among medical conditions, a history of cardiovascular and respiratory disease was the most frequent (31 %). Anxiety was present in 46.2 % of patients. More than half of the patients (51.2 %) were heavy smokers and 50.5 % were strongly nicotine dependent (Fagerström's score>7). Seventy percent were motivated to stop smoking and 53.8 % had tried to quit at least once. CONCLUSION: The majority of our patients could be considered as heavy smokers. Therapeutic combinations and medical treatment are suggested to assist practitioners trying to help them.

[Smoking behavior among nursing students in Sousse, Tunisia: a preliminary study]. / Comportements tabagiques chez les étudiants infirmiers de Sousse, Tunisie: étude préliminaire.

INTRODUCTION: Smoking is an entirely preventable, man-made, epidemic. It is a major, worldwide, public health problem whose social costs are very high. Health care workers have an important role to play in tobacco control. We conducted a study among nursing students to examine their smoking behavior, their attitudes towards smoking, and their participation in prevention. METHODS: This descriptive, transverse study was conducted in March 2011 during which an anonymous self-completion questionnaire was administered to nursing students. RESULTS: The study included 150 students aged between 18 and 25 years with a sex ratio of 1:3. The prevalence of smoking was 32.6%. Male students began smoking at an earlier age (16.5±2.3 years vs 18.9±1.1 years). The main initiating factors were stress (55%), pleasure (46.9%) and peer influence (36.5%). The Fagerstrom score showed a high level of dependency in 26.5% of smokers. More than 75% of student smokers have tried to quit. Most of the students surveyed (93%) think that health care workers should set a good example by not smoking and 91% of them think they should help others quit smoking. CONCLUSION: Health care workers should be well informed about the harmful effects of tobacco. They should be convinced of the need for their participation in smoking prevention and the fight against this medico-social scourge. It is essential that their training prepares them for this task and that their environment helps them fulfill their responsibility.

[Prevalence and correlates of major depressive episodes in Sousse primary care setting: assessment with the Tunisian version of CIDI]. / Prévalence et facteurs associés des épisodes dépressifs majeurs : Evaluation par la version tunisienne du CIDI dans les structures de première ligne de Sousse.

BACKGROUND: Major depression is a mental disorder that is associated with high morbidity and significant mortality. It is common among primary care attenders. Few is known about major depression prevalence and associated factors, which would prevent general practitioners from diagnosing it in primary care centres and treating it adequately. AIM: To determine prevalence and correlates of major depressive episodes (MDE) in a representative sample of primary care attenders in the area of Sousse (Tunisia). METHODS: A random and representative sample of primary care attenders was obtained by a two-stage sampling procedure. First, 30 primary care centres (20 urban and 10 rural) were selected, with stratification according to residency location. Second, 1246 consenting participants were systematically recruited among those centres attenders. Participants were screened, by trained interviewers, with Tunisian version of « Composite International Diagnostic Interview ¼ CIDI.2.1. After data entry in ishell program, MDE diagnosis was obtained according to ICD-10 criteria. RESULTS: Mean age in our sample was 43.4 ± 17.62 years, with feminine (70.9 %) and urban (67.8 %) predominance. MDE was found in 26.4 % of participants. Associated factors were female gender, marital statute of widowed or divorced and rural residency. CONCLUSION: This study provided data about high prevalence of MDE in the area of Sousse primary care centres and its correlated factors.

[Comparative study of C-reactive protein and procalcitonin in the severity diagnosis of pyelonephritis in children]. / Étude comparative de la protéine C-réactive et de la procalcitonine dans le diagnostic de sévérité des pyélonéphrites aiguës de l'enfant.

OBJECTIVE: The aim of this study is to compare two biologic parameters; C-reactive protein (CRP) and procalcitonin (PCT) in the detection of acute renal lesions assessed by DMSA scintigraphy in the urinary tract infection in child. DESIGN: In a prospective study, serum PCT, CRP and leukocyte counts were measured for children admitted, between January and December 2010, with a first episode of febrile urinary tract infection. RESULTS: Seventy-five children were enrolled in the study. Thirty-three patients had renal lesions (group A) and 42 had a normal DMSA scintigraphy (group B). The mean PCT level was significantly higher in group A than in group B (8.81 ng/mL versus 1.7 ng/mL, P=0.01). In this study, using receiver operating characteristic (ROC) curve, we identified that the optimal cut-off value with ideal sensitivity and specificity for PCT in detection of renal lesions was 0.76 ng/mL and for CRP, it was 70 mg/L. The sensitivity, the negative predictive value and the indice of Youden of the cut-off value of PCT were significantly higher than CRP (82% versus 70%; 84% versus 70% and 0.58 versus 0.25). CONCLUSIONS: This study confirmed that the serum PCT level was more sensitive and specific than the CRP in the detection of renal lesions in the first urinary tract infection in child.

Diffuse primary malignant melanoma of the upper gastrointestinal tract.

Primary malignant melanomas of the GI tract are very rare. Their symptomatology is not specific. We report a 78-year-old Tunisian woman hospitalised with a 6-month history of recurrent abdominal pain, loss of appetite, weakness and weight loss. She had no personal history of cutaneous or ocular melanoma. Upper gastrointestinal endoscopy revealed multiple small, raised darkly pigmented tumours. Theses lesions were found in the oesophagus, the stomach, the bulb and the duodenum. Biopsy specimens were taken and histology showed the presence of melanocytic cells with abundant melanin pigment. Immunohistochemically, tumour cells were positive for HMB-45. Morphological examinations revealed hepatomegaly with multiple nodules with small lymph nodes at the celiac axis. All available diagnostic procedures failed to identify any other site of ocular or cutaneous melanoma, the present case was considered as primary GI melanoma. Palliative chemotherapy was not possible because patient was extremely cachectic and she died one month later.

Study of 47 consecutive patients with peptic esophageal stricture compared with 3880 cases of reflux esophagitis.

The purpose of this study, making use of systematic records on computer over a period of 12 years, was to compare the prevalence and the demographic characteristics of patients with peptic stricture with those having a reflux esophagitis. As compared with 3880 cases of erosive and/or ulcerative esophagitis, the percentage of peptic stricture patients was 1.21%. The latter were on average nine years older and more frequently had a hiatus hernia. Ten patients with peptic stricture had had severe esophagitis previously recorded in our department. Thirty-four peptic stricture patients (72.3%) had at least one condition reported as possibly provocative of stricture. This study stresses the point that the incidence of peptic esophageal stricture is probably far lower than had been reported previously. Consequently, management of low-grade reflux esophagitis should be aimed primarily at relieving symptoms rather than healing esophageal lesions to prevent stricture.