Prevalence and impact of diabetes mellitus in hospitalized COVID-19 patients in a Tunisian Center: a cross-sectional study.

Background: The outbreak of the coronavirus disease 2019 (COVID-19) has become an evolving worldwide health crisis. With the rising prevalence of diabetes mellitus has come an increasing awareness of their impacts on infectious diseases, and the risk for postinfection complications and mortality from critical infections. Objective: The objective of this study was to evaluate the prevalence and impact of diabetes mellitus on the severity and mortality of COVID-19. Methods: Data of laboratory-confirmed hospitalized patients at the COVID-19 unit between September 2020 and August 2021 were analyzed, in a cross-sectional study. The population was classified into two groups: COVID-19 patients with and without diabetes. Primary outcomes were the overall length of hospital stay, the admission to the ICU, and death. The association between diabetes and death was assessed in a Cox proportional hazards model. Results: A total of 866 patients were included. There were 270 (31.2%) patients with diabetes. Diabetic patients were more likely to have hypertension (58.1 vs. 33.4%), cardiovascular disease (18.5 vs. 10.4%), and dyslipidaemia (17.8 vs. 7.2). Overall, 263 patients died, among them only 86 in the diabetic group (P=0.523). Patients with diabetes had a higher risk of developing complications (P<0.001). Multivariate Cox regression analysis showed that diabetes was not significantly associated with death [HR (95% CI): 1.253 (0.963-1.631)]. Conclusion: Diabetes was associated with a greater risk of complications in patients with COVID-19. Special attention to diabetic patients during treatment must be given to avoid these complications.

Patients' perception of the quality of care at the Ibn Al Jazzar University Hospital in Kairouan, Tunisia.

AIM: This study aims to evaluate the level of satisfaction of patients hospitalized at Ibn Al Jazzar University Hospital of Kairouan in 2018. METHODS: It's a descriptive cross-sectional study including all patients hospitalized at Ibn Al Jazzar University Hospital in Kairouan over a period of three months, from January 1 to March 31, 2018. The survey was conducted using a questionnaire made up of 27 items to explore seven specific dimensions of satisfaction. RESULTS: A total of 640 patients was included in the study. The overall satisfaction rate was 41.7%. The dimensions of globality and hospital stay were the least appreciated by hospitalized patients with respective satisfaction rates of 14.4% and 18.3%. Access to care was the most appreciated area with a satisfaction rate of 58.9%. the lowest satisfaction rates, among the items studied at the Kairouan University Hospital in 2018 were: «the places of visits¼ (9%), «the quality of the catering¼ (20%), « tranquillity" (23%), and "attentiveness of staff to patient needs" (23%). CONCLUSION: At Ibn Al Jazzar University hospital of Kairouan, patient satisfaction was low regarding the quality of the services provided, particularly for areas related to the conditions of stay and the globality of care. Intervention measures based on these shortcomings should be undertaken.

Place of distancing measures in containing epidemics: a scoping review.

Distancing is one of the barrier measures in mitigating epidemics. We aimed to investigate the typology, effectiveness, and side effects of distancing rules during epidemics. Electronic searches were conducted on MEDLINE, PubMed in April 2020, using Mesh-Terms representing various forms of distancing ('social isolation', 'social distancing', 'quarantine') combining with 'epidemics'. PRISMA-ScR statement was consulted to report this review. A total of 314 titles were identified and 93 were finally included. 2009 influenza A and SARS-CoV-2 epidemics were the most studied. Distancing measures were mostly classified as case-based and community-based interventions. The combination of distancing rules, like school closure, home working, isolation and quarantine, has proven to be effective in reducing R0 and flattening the epidemic curve, also when initiated early at a high rate and combined with other non-pharmaceutical interventions. Epidemiological and modeling studies showed that Isolation and quarantine in the 2009 Influenza pandemic were effective measures to decrease attack rate also with high level of compliance but there was an increased risk of household transmission. lockdown was also effective to reduce R0 from 2.6 to 0.6 and to increase doubling time from 2 to 4 days in the covid-19 pandemic. The evidence for school closure and workplace distancing was moderate as single intervention. Psychological disorder, unhealthy behaviors, disruption of economic activities, social discrimination, and stigmatization were the main side effects of distancing measures. Earlier implementation of combined distancing measures leads to greater effectiveness in containing outbreaks. Their indication must be relevant and based on evidence to avoid adverse effects on the community. These results would help decision-makers to develop response plans based on the required experience and strengthen the capacity of countries to fight against future epidemics. Mesh words: Physical Distancing, Quarantine, Epidemics, Public Health, Scoping Review.

Place of the periodic medical check-up in basic health care in Tunisia.

The objective of primary health care is to reduce mortality and morbidity. This kind of care was very efficient in communicable diseases, malnutrition and maternal and neonatal diseases; however, their impact on non communicable diseases and mental disorders control is not obvious. In Tunisia, primary health care was introduced in the early 1980s; a lot of progress were notified in particular in health of mothers and children in particular, but only slightly in non communicable diseases control and mental health promotion. Therefore, a new approach would be strongly recommended to remedy this situation. The Medical Periodic Check-up (MPC) implemented in North America would have a positive impact in the prevention and management of non communicable diseases. What would be the place of this MPC in primary health care in Tunisia? The MPC has two main objectives: the prevention of specific diseases and health promotion. However, despite its efficiency and usefulness, the MPC could be costly, especially for countries with limited resources. Current evidence suggests that the most appropriate approach would be to take periodic preventive health visits tailored to the level of risk. The frequency of visits depends on the age, sex and state of health of the individual. In conclusion, there are strong arguments in favor of the introduction of MPC in primary health care in Tunisia, especially among adults in non communicable diseases control strategy. However, it's highly be recommended that the BMC should be oriented according to the risk levels in order to optimize resources. It is also important to educate and the public, especially women and young adults, to benefit from periodic medical and dental examinations.

Burden of breast and gynecological cancers in Tunisia between 1990 and 2030: Trend and projection.

AIM: To describe the burden of breast and gynecological cancers in Tunisia in 2017, to analyze the trend between 1990 and 2017 and to performit's prediction by 2030. METHODS: This was a study using data estimated by the Institute for Health Metrics and Evaluation (IHME) for years of life by breast cancer and gynecological cancers: ovary, cervix and uterus (endometrium and other unspecified parts of the uterus) in Tunisia in 2017.The trend analysis of age standardized DALYrate between 1990 and 2017 was analyzed by using Join Point software.The projection of number of DALY and YLL by 2030 was conducted by SPSS software using Age-Period-Cohort (APC) models. RESULTS: In 2017, the age standardized DALYs rate for breast and gynecological cancers was 538.5/100,000 women. Breast cancer proved observed the highest rate of standardized DALY rate with 378.5/100,000 women followed by ovarian cancer (rate standardized DALY=72.7/100,000 women).The standardized DALY rate increased between 1990 and 2017 except for cervix cancer and uterine cancer which have been on a downward trend. According to the same conditions between 1990 and 2017, the age standardized DALY rate in 2030 will reach 674.6/100,000 women (95% CI=667.2/100,000-682.1/100,000). CONCLUSION: Strengthening prevention strategy against cancer in general and women's cancers in particularis strongly recommended to reduce cancer burden and to changeits trend.

Burden of road traffic accidents in the Greater Maghreb (1990-2017).

OBJECTIVE: To study the burden of Road Traffic Accidents (RTA) in the Maghreb and its evolution during the period 1990 to 2017. METHODS: We described the RTA in the Maghreb region, while analyzing database provided by the Institute for Health Metrics and Evaluation (IHME) for the period1990-2017. RESULTS: The age-standardized incidence rate of RTA has decreased overall across the Maghreb; it went from 719.57/100000 inhabitants in 1990 to 609.49 per 100,000 inhabitants in 2017. In 2017, the highest mortality rate in the region was noted in Tunisia and it was 30.15 / 100,000 inhabitants (CI95% = 24.05-37.08). The highest and lowest standardized rates for disability adjusted life years or DALYs were observed respectively in Tunisia: 1,311.56 per 100,000 inhabitants (CI95%=1,065.28-1588.68) and in Algeria: 962.68 per 100,000 inhabitants (CI95%=789.50- 1460.12). CONCLUSION: The burden of disease from road accidents is high in the Maghreb countries and the downward trend in the incidence of these accidents is relatively low. These results should encourage decision-makers to elaborate an integrated and multisectorial strategy to improve the situation.

Effectiveness of hand hygiene in an epidemic context. Systematic review.

OBJECTIVE: To assess the effectiveness of Hand Hygiene (HH) in preventing infections and the transmission of pathogens, in an epidemic context, in community and hospital settings. METHOD: It is a systematic review of the literature based on a document request, conducted on PubMed, using the following search equation: "(" Hand Hygiene "[All Fields] OR" Hand Disinfection "[All Fields]) AND ("Epidemics" [All Fields] OR "Pandemics" [All Fields]) ". All publications related to the effectiveness of the preventive intervention for HH in an epidemic setting were Included. RESULTS: A total of 16 publications were included, of which the majority proved the effectiveness of HH and its promotion in reducing infections during an epidemic. In a clinical trial, promoting HH in an intervention group significantly reduced the prevalence of infections (24.4% vs. 11.1%). Two systematic reviews have shown the effectiveness of HH in preventing the transmission of germs with ORs between 0.52 and 0.62. Four case-control studies and three cross-sectional studies concluded with the protective effect of HH with ORs varying between 0.06 and 0.71. A cohort study showed that low adherence to HH recommendations was associated with a higher infection rate (77.5% vs 95%; p = 0.02). A single systematic review did not conclude that HH was effective in the epidemic setting. CONCLUSION: The effectiveness of HH in the fight against epidemics has been demonstrated. It is dependent on the engagement and the active participation of the different intervenient. Hence the need to increase accessibility to different methods of HH and to promote the importance of this prevention strategy could be assured through education and awareness.

[Incidence and risk factors of surgical site infection following caesarean section in a Tunisian maternity unit]. / Incidence et facteurs de risque de l'infection du site opératoire après césarienne dans une maternité de Tunisie.

INTRODUCTION: Surgical site infection (SSI) is a major health concern and is one of the most common complications following caesarean section, with an incidence of 3%-15%. With the worldwide increase in caesarean section rates, the incidence of SSI is expected to increase in parallel. This study was designed to estimate the incidence and determine the risk factors of SSI after caesarean section in an Obstetrics and Gynaecology department in the Kairouan region in Tunisia. METHODS: A prospective cohort study of all patients who delivered by caesarean section between December 2015 and February 2016 was conducted in the Kairouan Obstetrics and Gynaecology department. The clinical status of these women was monitored during the 30-day postoperative period (in the outpatients department, emergency room or they were contacted by phone). A multivariate logistic regression model was used to identify risk factors. RESULTS: Of the 714 patients admitted for caesarean delivery, 636 (89%) were monitored for 30 days. Thirty-two of these women were diagnosed with SSI, corresponding to an incidence of 5% (95% CI = 3.3%; 6.6%). 87.5% (n = 28) of SSI were superficial and 12.5% (n = 4) were complex (deep and organ/space). Multivariate logistic regression analysis identified the woman's age as a risk factor of SSI (RR = 1.07 for every year increment, 95% CI = 1.007; 1.17), whereas drainage was identified as a protective factor (RR = 0.16, 95% CI = 0.05; 0.48). CONCLUSION: This study identified the incidence and risk factors of postoperative infection following caesarean section. Prevention of these infections should be a public health priority.

[Nosocomial infections in the Intensive Care Unit: annual incidence rate and clinical aspects]. / Les infections nosocomiales en milieu de réanimation: incidence annuelle et aspects cliniques au Service de Réanimation Polyvalente, Kairouan, Tunisie, 2014.

Although the number of ICU beds is generally limited, the incidence rates of nosocomial infections is high. Managing infectious risk in ICU is a priority today; one of the strategic aims is the establishment of systems for epidemiological control. The aim of our study is to determine the incidence and the clinical aspects in order to identify the risk factors. We conducted a longitudinal descriptive impact assessment study enrolling patients hospedalized for more than 48 hours in general purpose Intensive Care Unit at the Ibn El JAZZAR Hospital, Kairouan over a period of 1 year, from 01/03/2013 to 28/02/2014. The study focused on 265 patients whose average age was 39±20 years (18-93 years) with a sex ratio(M/F) of 2.48. We identified 125 episodes of nosocomial infections in 81 patients corresponding to a total incidence of 30.6%. The incidence density rate was 55 infections per 1000 days of hospitalization. There was a clear predominance of pneumopathies, with an incidence of 27.73%, followed by urinary tract infections (9,73%), infections associated with central venous catheter (6.25%) and surgical site infections (2.34%). Mortality rate of patients was 28.7%, with a significant difference between infected patients (44.7% of cases) and non-infected patients (29.07%) (p < 10-3). Gram-negative bacteria were found in 80% of cases. Prevention must involve a global and multidisciplinary action.

[Evaluation of the compliance rate of partograph use in a Tunisian Maternity ward: a targeted clinical audit]. / Évaluation de la conformité de la tenue du Partogramme dans une maternité Tunisienne: audit clinique ciblé.

Partograph is an essential tool in routine delivery room practices. It is a written reflection of the quality of mother and child health management during delivery and in the immediate post-partum period. Our study aims to assess compliance rate of partograph use within our maternity ward and to propose areas for improvement of its quality. We conducted a retrospective clinical audit of 400 patients? medical records who gave birth on the labour ward at University of Kairouan from 1 January to 31 December 2014. The reference guidelines used were those from the French Health High Authority (2006) containing 29 criteria divided into 3 categories (PARTOten, PARTOobs, PARTOeve). The overall compliance rate (OCR) of partograph use in our audit was 55.9%. With regard to the first area, such as « La tenue du partogramme ¼ (partograph use, PARTOten) the overall compliance rate was 88, 9%. With regard to the second area, such as « la traçabilité du déroulement du travail ¼ (track labor progression, PARTOobs) the overall compliance rate was 51, 4%. With regard to the third area, such as « la traçabilité des actes, des évènements et des traitements au cours du travail ¼ (the tracing of actions, events and treatments during labor, PARTOeve) the overall compliance rate was 27.4%. Our study has helped identify several areas for improvement. The ultimate goal of this clinical audit was the improvement of professional practices. Therefore, we implemented an action plan (training, awareness raising?) followed by a review aimed to verify the continuity of the corrective actions.