Knowledge and attitudes of healthcare workers about influenza vaccination.

BACKGROUND: Influenza infection is a highly contagious viral disease. It may cause several nosocomial outbreaks. This study aimed to evaluate the knowledge and attitudes of healthcare workers (HCWs) about influenza vaccination and to identify factors associated with the uptake of influenza vaccination. METHODS: We conducted a cross-sectional study over 5 months between November 2021 and March 2022. Data was collected using an anonymous self-administered questionnaire. We included all HCWs at Taher Sfar University Hospital who were willing to participate in the study. RESULTS: A total of 395 HCWs were included. They were mainly women (78.7%) with an average age of 27 years. The medical personnel was the largest group (67.8%). Most respondents considered the vaccination to be optional and knew that it should be renewed every year, but 97.5% of them judged the efficacy of the vaccine to be low. The influenza vaccination uptake was only 20.2%. The main reasons for accepting vaccination were to protect patients and families. However, misconceptions about the severity and the risk of influenza and the belief that barrier measures were sufficient to prevent infection were the main causes of avoiding vaccination. The factors associated with adherence to vaccination were being a medical professional, old age, longer professional experience, and considering vaccination to be mandatory for HCWs. CONCLUSION: Our study showed a low adherence to influenza vaccination with misconceptions about vaccine efficacy and safety. More efforts are needed to improve the knowledge of HCW about the vaccine and boost the adherence rates.

A Case of Painful Diplopia after COVID-19 Vaccination: Could It Be Tolosa-Hunt Syndrome?

Herein, we report a rare case of Tolosa-Hunt syndrome (THS) following coronavirus disease 2019 (COVID-19) vaccine administration. A 64-year-old patient presented with recurrent horizontal diplopia and ipsilateral orbital pain, 2 weeks after being administered the COVID-19 vaccination. A diagnosis of THS was based on the relevant criteria after ruling out the differential diagnoses. The clinical presentation improved with corticosteroid administration. THS must be recognized as a complication of COVID-19 vaccination. This association can be explained by an autoimmune response.

A Case of Acute Pancreatitis: An Unusual Manifestation of Acute Q Fever.

Acute pancreatitis is a sudden inflammation affecting the exocrine region of the pancreatic parenchyma. Infectious etiologies are rare. Here we report an exceptional case of a 44-year-old woman from a rural area who was referred to our hospital with fever and abdominal pain. A physical examination revealed pale skin and epigastric tenderness. Thoracoabdominal computed tomography revealed a Balthazar score of D. Serum laboratory findings revealed hemolytic anemia, hepatic cytolysis, and high C-reactive protein level. Calcium and lipase levels were normal. There was no history of recent trauma, alcohol consumption, or drug intoxication. The diagnosis of "query" pancreatitis was confirmed by serological Coxiella burnetii positivity. Oral doxycycline 200 mg daily was initiated. The clinical evolution was favorable. To our knowledge, no association between acute pancreatitis and hemolytic anemia caused by C. burnetii was reported previously. Q fever must be considered in cases of acute pancreatitis, especially when the patient is from a rural area or has a high-risk profession.

Acute arthritis following SARS-CoV-2 infection: About two cases.

Joint involvement in COVID-19 may occur at different stages of the disease and maybe represented by non-specific arthralgia or by acute arthritis. We report two cases of COVID-19 infection that were complicated by postviral reactive arthritis. Case 1: A 47-year-old male was presented 20 days after a COVID-19 infection with acute right knee arthritis. On biologic data, erythrocyte sedimentation rate and C-reactive protein were normal, and immunologic data were negative. A joint puncture was performed showing a turbid fluid. Testing for microcrystals was negative, as well as the synovial fluid culture. An infectious investigation was conducted, which was negative. The patient's complaints improved significantly, with analgesics and non-steroidal anti-inflammatory drugs (NSAID). Case 2: A 33-year-old female presented with acute left knee arthritis evolving for 48 h, free of fever, after a COVID-19 infection treated 15 days ago. On examination, besides knee arthritis, the osteoarticular examination was normal. A biological inflammatory syndrome was noted in laboratory tests. A yellow fluid with multiple PNN was detected in the joint fluid aspiration, with a negative culture. The patient was treated by analgesics and NSAID. The follow-up was highlighted by the arthritis resolution. Conclusion: Both of our cases are consistent with what has already been reported in the literature confirming the development of PostCOVID arthritis and strengthen the impending necessity of wider studies to identify rheumatologic manifestations in the short- and long-terms after surviving COVID-19.

A clinical trial about effects of prebiotic and probiotic supplementation on weight loss, psychological profile and metabolic parameters in obese subjects.

INTRODUCTION: The management of obesity is difficult with many failures of lifestyle measures, hence the need to broaden the range of treatments prescribed. The aim of our work was to study the influence of pre and probiotics on weight loss psychological profile and metabolic parameters in obese patients. METHODS: It is a clinical trial involving 45 obese patients, recruited from the Obesity Unit of the National Institute of Nutrition between March and August 2022 divided into three groups: diet only (low-carbohydrate and reduced energy diet), prebiotics (30 g of carob/day) and probiotics (one tablet containing Bifidobacterium longum, Lactobacillus helveticus, Lactococcus lactis, Streptococcus thermophilus/day). The three groups were matched for age, sex and BMI. Patients were seen after 1 month from the intervention. Anthropometric measures, biological parameters, dietary survey and psychological scores were performed. RESULTS: The average age of our population was 48.73 ± 7.7 years, with a female predominance. All three groups showed a significant decrease in weight, BMI and waist circumference with p < .05. Only the prebiotic and probiotic group showed a significant decrease in fat mass (p = .001) and a significant increase in muscle strength with p = .008 and .004, but the differences were not significant between the three groups. Our results showed also a significant decrease in insulinemia and HOMA-IR in the prebiotic group compared to the diet-alone group (p = .03; p = .012) and the probiotic group showed a significant decrease in fasting blood glucose compared to the diet alone group (p = .02). A significant improvement in sleep quality was noted in the prebiotic group (p = .02), with a significant decrease in depression, anxiety and stress in all three groups. CONCLUSIONS: The prescription of prebiotics and probiotics with the lifestyle measures seems interesting for the management of obesity especially if it is sarcopenic, in addition to the improvement of metabolic parameters and obesity-related psychiatric disorders.

Cross sectional study about nutritional risk factors of metabolically unhealthy obesity.

INTRODUCTION: A substantial proportion of obese subjects are metabolically healthy and free from metabolic complications. Many mechanisms that could explain the existence of the metabolically healthy obese phenotype have been suggested, involving in particular a healthy lifestyle and diet. The aim of this study was to study the anthropometric, nutritional and biological profile of two groups: obese with metabolic syndrome (MS+) and obese without metabolic syndrome (MS-). METHODS: It is a cross-sectional study, conducted between January 2022 and 15 March 2022. We recruited 90 obese MS+ and 82 obese MS - . Both groups were matched for age and sex. The glycemia, triglycerides (TG), total cholesterol (TC), HDL-C, LDL-C were measured as well as the body composition and anthropometric data. The diet was determined by the 24-hour recalls. Eating disorders, sleep disorders (PSS4 scale) and depression (HADS) were also searched. RESULTS: In MS+ group we noticed: higher BMI, waist circumference, more caloric diet, elevated consumption of saccharides. This group had more eating disorders such as night eating syndrome and bulimia and sleeping disorders (sleep onset and total insomnia). MS + group was more stressed and depressed. The MS - group had a Mediterranean diet and had more intake of: EPA, DHA, olive oil, green tea, oleaginous fruits, linseed, vegetables and whole grains. They also practiced more fasting. CONCLUSIONS: It is important to know the protective nutritional factors of the metabolic syndrome in order to be able to focus on them during education sessions and thus protect the obese from metabolic complications.

Case Report: Optical coherence tomography angiography findings in radiation retinopathy.

We reported the observation of a 31-year-old female followed for a nasopharyngeal carcinoma since 2009, treated by locoregional radiotherapy, with a cumulative dose of 75 Gray. The patient presented with a progressive decline in bilateral vision. Ophthalmologic examination revealed bilateral dry eye, posterior subcapsular cataract, radiation retinopathy, and optic neuropathy. The patient presented all ocular complications of radiotherapy. The most severe was radiation retinopathy. Performing optic coherence tomography angiography (OCT-A) earlier could have speeded up the diagnosis and led to a better prognosis. The OCT-A showed more pronounced macular edema in the right eye, and revealed enlargement of the central avascular zone and loss of the deep and superficial retinal vascular network. The patient received three consecutive monthly intravitreal injections of anti-vascular endothelial growth factor. Yet, we noted a non-improved visual acuity. The aim of this case report was to present the contribution of OCT-A in the diagnosis of radiation maculopathy and attribute these changes to ischemia at the level of the retinal vascular network.

Plasmatic Magnesium Deficiency in 101 Outpatients Living with Type 2 Diabetes Mellitus.

(1) Background: Magnesium deficiency is usually associated with type 2 diabetes mellitus (T2DM). Individuals living with T2DM with hypomagnesemia show a more rapid disease progression and have an increased risk for diabetes complications. (2) Methods: This is a cross-sectional and descriptive study in the National Institute of Nutrition and Food Technology of Tunis in Tunisia, including all adult outpatients (≥18 years old) with a diagnosis of T2DM from 1 September 2018 to 31 August 2019. The aim of this study was to evaluate the prevalence of plasmatic magnesium deficiency in a Tunisian population of T2DM and to study the relationship between magnesium status and intake, glycemic control and long-term diabetes-related complications. (3) Results: Among the 101 T2DM outpatients, 13 (12.9%) presented with a plasmatic magnesium deficiency. The mean age was 56 ± 7.9 years with a female predominance (62%, n = 63). The mean of the plasmatic magnesium level was 0.79 ± 0.11 mmol/L (0.5-1.1), and the mean of 24 h urinary magnesium excretion was 87.8 ± 53.8 mg/24 h [4.8-486.2]. HbA1c was significantly higher in the plasmatic magnesium deficiency group than the normal magnesium status group (10% ± 1.3 vs. 8.3% ± 1.9; p = 0.04), with a significant difference in participants with a poor glycemic control (HbA1c > 7%) (100%, n = 13/13 vs. 53%, n = 47/88; p = 0.001). A weak negative relationship was also found between plasmatic magnesium and HbA1c (r = -0.2, p = 0.03). Peripheral artery disease was more commonly described in individuals with low plasmatic magnesium levels than in individuals with normal levels (39%, n = 5 vs. 0%, n = 0; p < 0.001). The mean plasmatic magnesium level in participants without diabetic nephropathy and also peripheral artery disease was significantly higher compared to individuals with each long-term diabetes-related complication (0.8 mmol/L ± 0.1 vs. 0.71 mmol/L ± 0.07; p = 0.006) and (0.8 mmol/L ± 0.1 vs. 0.6 mmol/L ± 0.08; p < 0.001), respectively. (4) Conclusions: Hypomagnesemia was identified in individuals with T2DM, causing poor glycemic control and contributing to the development and progression of diabetes-related microvascular and macrovascular complications.

Case Report: Recurrent retinal vein occlusion as the first clinical manifestation of systemic lupus erythematosus in a male patient.

Systemic lupus erythematosus (SLE) is a chronic, autoimmune disease characterized by widespread clinical manifestations and immunological disorders. A myriad of ocular manifestations can be seen in patients with SLE. The most vision-threatening complication is vaso-occlusive retinopathy including retinal vein occlusion (RVO). RVO associated with SLE is well described in the literature and its association with antiphospholipid antibodies is recognized. However, RVO as the initial manifestation of SLE is scarcely reported. Herein, we report the first case of recurrent RVO as the revealing manifestation of SLE in a 40-year-old male patient. He had two consecutive episodes of decreased vision. Ophthalmologic examination disclosed a branch retinal vein occlusion the first time and a central retinal vein occlusion the second time. The diagnosis of SLE was established based on clinical and immunological criteria. He was prescribed antiplatelet therapy, hydroxychloroquine at 5.5 mg/kg/day, and intravitreal anti-vascular endothelial growth factor (VEGF) antibodies regimen. He slowly improved under treatment.

Impact of sleeve gastrectomy on abnormalities in carbohydrate tolerance in obese adult.

INTRODUCTION: Facing the repeated failures of the medical management of obesity, bariatric surgery offers a promising therapeutic option in terms of achieving weight loss and metabolic benefits. AIM: To evaluate the impact of sleeve gastrectomy on the carbohydrate profile of a group of obese subjects. METHODS: It is a prospective study including 40 obese patients (7 Men and 33 Women) who underwent sleeve gastrectomy between 2016 and 2018. Clinical and biological parameters were collected before the intervention, at six months and one year after. Insulin resistance was defined by a HOMA-IR index ≥2.4. Remission of diabetes was determined using the American Society for Metabolic and Bariatric Surgery's (ASMBS) criteria. RESULTS: The mean patients' age was 34.65 ± 8.17 years. The mean body mass index (BMI) was 50.23 ± 8.3 kg/m². One year after sleeve gastrectomy, the frequency of insulin resistance, decreased from 89% to 4% (p<0.05). The evolution of carbohydrate tolerance abnormalities was marked by the diabetes and prediabetes remission in 75% and 100% of cases, respectively. The mean excess weight loss was 55.8% at 12 months. CONCLUSION: These results have expanded our knowledge of the short-term sleeve gastrectomy's effectiveness on the carbohydrate profile of obese subjects. However, it would be interesting to check the durability of this metabolic benefit in the medium and long term.

Eating disorders in type 1 diabetic adolescent.

BACKGROUND: Adolescents with type1 diabetes appear to be at greater risk for developing eating disorders (ED) which are often associated with impaired metabolic control of diabetes. AIM: To estimate the prevalence of ED in a population of adolescents with type 1 diabetes (T1D) and to identify risk factors associated with this disorder in order to propose preventive measures. METHODS: A cross-sectional, population-based study involved 102 adolescents with type 1 diabetes, aged 11-18 years, recruited from the National Institute of Nutrition in Tunis, Tunisia over a period of one-year January 2017-January 2018. RESULTS: The prevalence of ED was 33.3%. It was significantly higher among girls (46.2% vs 20%, p = 0.005). Unspecified ED were predominant with a prevalence of 29.4%. Independent factors associated with ED were female sex, abdominal obesity and quality of life. The risk of developing ED was multiplied by 3.5 for women (adjusted OR = 3.5 and CI95% [1.4-8.6]) and by 5.6 for patients with abdominal obesity (Adjusted OR = 5.6 and CI95% [1.5-20.4]). Impaired quality of life and specifically anxiety about diabetes increased significantly the risk of developing ED in our patients. However, we didn't find significant association between ED and age, family characteristics, duration of diabetes, metabolic balance, treatment and complications of diabetes. CONCLUSION: We concluded that ED should be always suspected in adolescents with T1D especially in girls. Unspecified ED are more common in this group of patients. Treatment of diabetes requires a multidisciplinary care approach including diabetologist, dietician and psychiatrist in order to promote healthy eating and to improve quality of life of adolescents with T1D.

Combined sclerosis of the spinal cord revealing Biermer's anemia: about a case.

Biermer's anemia is an auto immune disease that can lead to neurological manifestations. Medullary combined sclerosis accounts for only 10% of neurological complications. There are few reports of documented bone marrow involvement by magnetic resonance imaging (MRI). Observation: We report a case of combined sclerosis of the cervical spinal cord assessed by cerebro-medullary MRI in a context of vitamin B12 deficiency in a 36-year-old patient who was hospitalized in the intensive care unit for septic shock with respiratory starting point, requiring the use of mechanical ventilation for 13 days and the discovery in post-extubation of pancytopenia with macrocytic anemia and flasquo-spasmodic tetraparesis prompting an emergency MRI showing combined sclerosis of the spinal cord , with vitamin B12 deficiency and megaloblastic anemia at the myelogram. The patient had benefited of vitamin therapy combined with a physical rehabilitation and the evolution was marked by a recovery of walking and normalization of biology after 2 months. Conclusion:    The advantage of medullary MRI in a severe clinical form with neurological impairment of vitamin B12 deficiency to guide the diagnosis. The treatment is based on vitamin therapy with a good evolution.

Impacts of nutritional education before Ramadan fasting on dietary intake, weight and body composition in diabetic patients.

BACKGROUND: The fasting period of Ramadan requires special attention for diabetic patients in particular. AIM: To determine the impacts of a nutritional education program before Ramadan fasting (RF) on dietary intake, anthropometry and body composition. METHODS: This was an interventional and comparative study including 54 type 2 diabetic patients, recruited at the National Institute of Nutrition. The patients were divided into two groups: an educated group who received a nutritional education session before Ramadan (n=26), and an uneducated group who did not receive any education (n=28). Food survey, anthropometry and body composition measurements were conducted before and after the month of Ramadan. RESULTS: During RF, a significantly decrease in carbohydrate intake was observed in both educated and uneducated patients (∆=-4.1 vs. ∆=-6.25). Lipid intake was increased significantly during RF for all patients. This increase was lower in patients receiving education compared to the other group (3.4±7.43 vs. 5.25±5.7). During RF, a significant increase in protein, saturated and monounsaturated fatty acids intake was shown in the uneducated group compared to educated group (respectively, ∆=1.19±2.30 vs. ∆ =1.06±7.10, ∆=3.40±7.43 vs. ∆=5.25±5.70 and ∆=2.23±5.60 vs. ∆=2.31±5.10). The weight loss was similar between the two groups of educated (-1.05 kg) and uneducated (-0.58 kg) patients. There was no significant change in body composition during Ramadan in both groups of diabetics. CONCLUSIONS: Nutritional education programs positively impact diabetic patients who prefer RF or insist to fast during Ramadan. These programs must be provided to diabetics before Ramadan.

[Corticosurrenaloma: an exceptional cause of primary hyperaldosteronism]. / Le corticosurrénalome: une cause exceptionnelle d'hyperaldostéronisme primaire.

Corticosurrenaloma is a rare malignant tumor of the adrenal gland that often secretes corticosteroids, sex steroids and precursors. Aldosterone-producing corticosurrenaloma is very rare, accounting for 1 case/10million inhabitants. We report the case of a 38-year old man presenting with severe arterial hypertension associated with deep hypokalaemia (2.2 mmol/L). Exploration showed primary hyperaldosteronism (aldosterone = 2645 pmol/l, aldosterone/renin ratio = 327 pmol/MUI), with hypersecretion of glucocorticoids. Abdominopelvic CT scan revealed left poorly differentiated and heterogeneous adrenal mass measuring 9cm, infiltrating into the surrounding adipose tissue and the diaphragm, extending into the left renal vein, with regional adenopathy and hepatic nodule measuring 4cm. The patient underwent radical nephrectomy followed by right hepatectomy two months after resulting in remission. A year after the patient developed lung metastases. This study highlights that corticosurrenaloma should be suspected in patients with primary aldosteronism despite its rarity.

Plasma Levels of Pentosidine, Carboxymethyl-Lysine, Soluble Receptor for Advanced Glycation End Products, and Metabolic Syndrome: The Metformin Effect.

Metabolic syndrome (MetS) is considered one of the most important public health problems. Several and controversial studies showed that the role of advanced glycation end products (AGEs) and their receptor in the development of metabolic syndrome and therapeutic pathways is still unsolved. We have investigated whether plasma pentosidine, carboxymethyl-lysine (CML), and soluble receptor for advanced glycation end products (sRAGE) levels were increased in patients with MetS and the effect of metformin in plasma levels of pentosidine, CML, and sRAGE. 80 control subjects and 86 patients were included in this study. Pentosidine, CML, and sRAGE were measured in plasma by enzyme-linked immunosorbent assay (ELISA). Plasma pentosidine, CML, and sRAGE levels were significantly increased in patients compared to control subjects (P < 0.001, P < 0.001, and P = 0.014, resp.). Plasma levels of pentosidine were significantly decreased in patients who received metformin compared to untreated patients (P = 0.01). However, there was no significant difference between patients treated with metformin and untreated patients in plasma CML levels. Plasma levels of sRAGE were significantly increased in patients who received metformin and ACE inhibitors (P < 0.001 and P = 0.002, resp.). However, in a multiple stepwise regression analysis, pentosidine, sRAGE, and drugs treatments were not independently associated. Patients with metabolic syndrome showed increased levels of AGEs such as pentosidine and CML. Metformin treatment showed a decreased level of pentosidine but not of CML. Therapeutic pathways of AGEs development should be taken into account and further experimental and in vitro studies merit for advanced research.