Developing learning objectives in postgraduate medical education for family medicine (Tunisia).

Introduction-Aim: The third cycle of medical studies (TCMS) lasts 3 years for the specialty of family medicine (FM) in Tunisia. The members of the FM committee of the Faculty of Medicine of Monastir (FMM) aimed to detail the learning objectives (LO) of residents in FM. METHOD: We used the Delphi method in 2 rounds including a group of experts called FM Learning Objectives Writing Group (FMLOWG) at the FMM. The FMLOWG included 74 university hospital physicians and FM internship supervisors. These members actively participated in the 10 meetings held during the month of March 2022. Three points were discussed: the identification of LOs; the development of training titles and the proposal of the teaching methods to be adopted. The writing was subdivided into 5 domains of LO: transversal, public health, typical population and by system. RESULTS: We identified 1359 LOs for FM residency, for which 552 were LOs per system (40.5%). The learning included 618 training session titles. Residents will have an academic training day every 3 weeks during 9 months for each TCMS year. CONCLUSION: A detailed, MF-specific consensus has been developed by majority of medical specialties. It will be a learning base for learners, a reference for supervisors and TCMS teachers.

Impact of the COVID-19 Pandemic on Orthopedic and Trauma Departments in Tunisia.

OBJECTIVE: Measure the effect of the strategy to fight the Covid-19 pandemic, based on containment, on the practice of orthopedic and trauma surgery in Tunisia. METHODS: This is a comparative study, concerning the impact of Covid-19 on the flow of patients, operated in orthopedic surgery and trauma departments, during the containment period from March 12, 2020 to April 30, 2020, comparing it to the same period of the year 2019, in the Central-East region of Tunisia (Kairouan, Sousse, Mahdia, Monastir). RESULTS: A significant decrease of 27% in the flow of patients admitted to orthopedic surgery departments in central-eastern Tunisia, during the 2020 containment period, compared to the same period of the previous year was documented. This decrease was generally widespread, notified in three orthopedic departments: Sousse (39%; p<10-3), Monastir (29%; p<10-3) and Mahdia (27%; p<10-3). It focused on the following three groups: infections (45%; p<10-3), wounds (30%; p<10-2), and fractures (20%; p<10-3). CONCLUSION: The collateral effects of the strategy to fight the Covid-19 pandemic, are "obvious" in orthopedic surgical practice. A health crisis management plan (including disasters and pandemics) should be better prepared in orthopedic surgery departments.

[Epidemiological profile of lateral epicondylitis in rehabilitation department]. / Profil épidémiologique des épicondylites latérales en milieu de rééducation.

INTRODUCTION: lateral epicondylitis, better known as tennis elbow, falls within the spectrum of upper extremity musculoskeletal disorders and it is a major public health problem. The purpose of our study was to determine the epidemiological and clinical profile and treatment modalities for patients with lateral epicondylitis followed at the Department of Physical Medicine and Rehabilitation. METHODS: we conducted a retrospective study (2012-2017) of patients with lateral epicondylitis referred to the Department of Physical Medicine and Functional Rehabilitation at the Tahar Sfar Mahdia University Hospital over a period of 6 years. Socio-demographic and clinical features as well as treatment modalities were assessed for each patient. RESULTS: fifty patients were enrolled in the study. The average age of patients was 44.82 years, with predominance of the female sex (72%). Half of our patients were active and the majority of them (60%) worked in a traditional office environment. Right upper extremity was most affected (78% of cases). The median duration of symptoms was 14.66 months. Clinical examination showed positive tendon triad in the lateral epicondyle in 96% of cases. Radiological examination was performed in 8 patients, ultrasound in 6 patients. All patients received analgesics, 84% of patients received non-steroidal anti-inflammatory drugs, only 8 patients received corticosteroid injections. One patient underwent surgery after therapeutic failure. Ninety-two percent of patients were scheduled for rehabilitation sessions. Total improvement was noted in 42% of patients, 46% reported transient improvement and 12% progressed to chronicity. CONCLUSION: lateral epicondylitis is a common cause of elbow pain. Its management in physical medicine is based on medical treatment and appropriate functional rehabilitation. However no therapeutic option seems clearly superior to the other.

Intramuscular cavernous haemangioma of the triceps.

A 16-year-old teenager presented himself with a swollen left elbow, with no associated vascular-nerve complications. The standard radiography was without abnormalities. The echography showed the presence of an oblong vascularized formation occupying the posterior part of the elbow. The magnetic resonance imaging (MRI) showed a hyper vascularized lesion developing at the expense of the brachial triceps muscle with an intermediate signal intensity on the sequences weighted in T1 and a hyper signal in T2. The anatomopathological study of the initial biopsy and of the tumor part concluded with a cavernous hemangioma. Although their origin is vascular, hemangiomas never metastasize and do not undergo malignant transformation. The treatment of symptomatic hemangioma consists of surgical excision.

COVID-19 and Management of Orthopedic Emergencies. Producing a Consensus of Experts.

OBJECTIVE: Report the results of a participatory approach in Tunisian orthopedic surgery, for the development of a consensus of experts, on the identification of the list of pathologies to always be considered as non-postponable emergencies, during the COVID-19 pandemic. MATERIAL AND METHODS: This descriptive study of the opinions of Tunisian experts covered all orthopedic morbidities classified into three homogeneous groups: trauma, infections and tumors of the musculoskeletal system. The attitudes of the interviewees were collected using the "Delphi" method, using a "Google-Form" questionnaire, sent by email to all of the Tunisian university orthopedic surgeons in practice, and registered at the SOTCOT. Consensus has been established for an item, if validated by at least 80% of the experts. The analysis of the results focused on the first 30 responses to this "online" form. RESULTS: Tunisian experts agreed on the continuity of the urgency of taking in charge all the items of orthopedic morbidity during the COVID-19 pandemic, apart from the following affections: aseptic nonunions in the upper and lower limbs, aggressive giant cell tumors, and hyperalgesic disc herniations, where agreement rates were only at 8%, 12%, 58% and 77%. CONCLUSION: Relative to its disciplinary and professional specificities, the majority the of orthopedic conditions were still considered as emergencies, during the COVID-19 pandemic, which did not lend to postponement of the surgery. However, their management should obey to the recommendations of "Sorting" and the " COVID-19 Patient Pathway ", established by national authorities.

Acute hematogenous osteomyelitis of the talus: a case report.

In children, osteomyelitis is common in the long bones of the femur and the tibia. However, talar osteomyelitis is extremely rare. The condition is difficult to diagnose due to the slow onset and atypical pattern of the symptom. We report the case of a 9-month-old male, coming from a rural area, with talar osteomyelitis. The patient's history of a trauma that resembled an ankle contusion had delayed the diagnosis and subsequently developed into septic arthritis. He was treated by curettage, immobilization in plaster and appropriate antibiotics with full recovery of function in his right ankle and foot three months after the first outpatient visit. The bony cavity was healed six months after the operation and there were no growth disturbances or any abnormalities of the adjacent joints. This case report aims to present the difficulties in the diagnosis and therapeutic approach of this disease.