Antibiotherapy management in respiratory infections in ambulatory in Tunisia

Acute respiratory tract infections are the commonest acute conditions managed in general practice and the main causes of antibiotic use. In Tunisia, the rates of antibiotic prescriptions remain high in general practice. In order to assess antibiotics prescribing practices of 23 general practitioners when facing an ENT or a respiratory tract infection, we conducted an observational study from February 1st, 2014 to November 25th, 2014. The study involved 374 patients, 45.6 mean age of years, among them 193 men (51.6%) and 174 (51.9%) with comorbidities. Tonsillitis, acute maxillary sinusitis and acute bronchitis are the main diagnosis, accounting for over 90% of ENT and respiratory tract infection. The diagnosis of these infections was based on clinical criteria, additional tests were prescribed for only 75 patients (20%). An antibiotic was prescribed for 360 patients (96.2%). β-lactams were the main prescribed class of antibiotics (58.3%). The antibiotic treatment was considered as inappropriate in 42.5% of prescriptions. The main causes were the prescription of amoxicillin-clavulanic acid during tonsillitis, non-antipneumococcal fluoroquinolones, when streptococci or streptococcus pneumoniae are presumed to be responsible for infection (tonsillitis, acute maxillary sinusitis, pneumonia), and unnecessary combination of antibiotics. A concomitant treatment was prescribed for 365 patients (97.6%). The most prescribed drugs were antipyretics (71.4%), corticosteroids (44.7%) and mucolytic (30.2%). The outcome was favorable in 333 cases (89%) and unfavorable in 26 cases (7.1%). The total average cost of an infectious episode was 79.776 ± 36.988 TND (45 ± 20 USD)., with a minimum and maximum values respectively 19.5 and 315.5 TND (35 to 558 USD). This study highlights the frequency of antibiotics prescription (96.2%) during supposed viral infections such as acute bronchitis, tonsillitis or when antibiotic prescription has to be debatable such as in acute otitis media, sinusitis maxillary or exacerbations of COPD. The over-use of antibiotics is an important concern in many countries of the region leading to emergence of bacterial resistance. National guidelines should be developed in order to promote rational use of antibiotics

Computational Modeling for Dense Gas Dispersion for Variable Stability Classes

The spill of many chemicals such as Liquefied Natural Gas (LNG) on land or water results in its rapid vaporization and the formation of a dense cloud. The performance of a risk assessment for the spill of flammable chemicals requires the determination of the maximum downwind distance where the Lower Flammability limit (LFL) is reached. The modeling of such spills is usually divided in two parts: source term and atmospheric dispersion. The source term describes the cryogenic liquid release rate and conditions. The atmospheric dispersion describes the increasing cloud propagation downwind after the release and the extent of the LFL distance until a steady state is reached. The focus of this work is the preparation of a model for the atmospheric dispersion after the spill of LNG on land using Computational Fluid Dynamics (CFD). CFD is a model based on solving Navier Stokes equations (conservation equations of mass, momentum and energy) in a specific 3D domain. The use of CFD as a tool for the prediction of dense clouds dispersion and LFL distance calculation by industry and research institutions is increasing significantly because it provides an adequate description of the phenomena of dense gas flow, dispersion and it can handle complex geometries. The objective of this research project is to prepare a CFD scheme for vapor cloud dispersion resulting from accidental spill of cryogenic liquid on land using CFD (FLUENT) for medium scale LNG/LN2 spill experiments to be performed at the Ras Laffan Emergency and Safety College (RLESC). The validation of the CFD (FLUENT) model is performed using dense gas dispersion data from literature (Prairie Grass). There is a lack of dense gas dispersion modeling for the unstable class because of the complexity of velocity, temperature and turbulence equations for this class. This model should be able to predict the dense cloud vapors dispersion for different stability classes (neutral, stable and unstable). A crucial parameter in the modelling of the dispersion of the dense gas is the choice of the turbulence model. There is currently no agreement on which model performs better for this application. This work involves a sensitivity analysis of the dispersion results to determine the choice of the turbulence model. The focus will be on three turbulence models which are the most used for this application: standard k – ε , realizable k – ε and Reynolds Stress Model RSM. The results from the modeling of three sets of Prairie Grass experiments suggest a good agreement between the simulation and experimental results only for the centerline concentration and for the stable and neutral classes. For the unstable class, there is a considerable overprediction of the centerline concentration. This work includes an attempt to compare model predictions with experimental concentrations at each location. Only centerline concentrations or highest concentrations were considered in previous works. Form this comparison; all three models were unable to predict the concentration measurements accurately. The RSM model yields relatively the best results for atmospheric an dispersion modelling compared to the standard k-ε and realizable k-ε models. As a result, it is advised to use this model for this application

Endoscopic meatotomy in the treatment of ureterocele: results in adult patients

To evaluate the efficacy of endoscopic meatotomy in the treatment of ureterocele in adults. A retrospective study of adult patients with ureterocele, treated between January 1987 and December 2014. In 47 patients, 55 intravesical ureteroceles were diagnosed and classified as 18 right, 21 left and eight bilateral (38%, 44% and 17% respectively). According to the Bruézière classification, 41 (75%) ureteroceles were type A and 14 (25%) others were type C. These ureteroceles were complicated by calculus formation in 22 cases, moderately dilated excretory pathways in 16 cases and both complications in a total of 9 cases. Four patients had a complicated ureterocele with pyelonephritis, one of which was emphysematous. The endoscopic treatment was performed in cases of complicated and/or symptomatic ureteroceles. Fifty one cases were treated by a "smiling mouth" meatotomy consisting in a transverse horizontal incision, with the treatment of any associated complication. The mean operative time was 35 minutes (10-90). The operative follow-up was uneventful in 42 patients and complications occurred in 5 patients (2 urinary retentions, 2 infectious complications and one hematuria). The mean duration of postoperative stay was 1-2 days. The mean follow-up was 15 months. Four patients developed vesicoureteral reflux and no stenosis was noted. The endoscopic incision of the ureteroceles seems today, after reviewing the results, to be a good treatment of adult ureterocele. It is a simple, minimally invasive and has a low morbidity rate

Diagnostic et prise en charge des cystites à éosinophiles

La cystite à éosinophiles est une pathologie inflammatoire de la paroi vésicale. Elle est rare, il n'existe pas des recommandations établies concernant sa prise en charge. Il s'agit d'une étude rétrospective ayant concerné dix observations de cystites à éosinophiles diagnostiquées et prises en charge dans notre service entre 2006 et 2017. L'âge moyen des patients était de 46 ans. On a noté une prédominance masculine. Un terrain atopique était noté dans 3 cas. Le mode de présentation le plus fréquent était des signes urinaires irritatifs dans 9 cas, une hématurie macroscopique dans 8 cas et des algies pelviennes dans 6 cas. Une hyper-éosinophilie sanguine était présente dans 4 cas. La cystoscopie avait montré des pétéchies dans 5 cas, un aspect pseudo-tumoral dans 4 cas et était normal dans un cas. Pour les formes pseudo-tumorales une résection endoscopique a été pratiquée. Quatre patients ont été traités par les anti-inflammatoires non stéroïdien, avec amélioration des symptômes. Six malades ont été surveillés. Après un recul moyen de 50 mois, aucune récidive n'a été rapportée. La cystite à éosinophiles est une pathologie rare. La présentation clinique est non spécifique. La prise en charge repose sur des moyens médicaux non invasifs dans les formes peu symptomatiques

Elective surgery cancellations in pediatric surgery: rate and reasons

Abstract Introduction Canceling pediatric elective surgery leads to multiple disturbances regarding the inefficient operating room (OR) management, the financial repercussions, and the psychological impact on the patient and his family. This study aims to identify the reasons for cancellations among the pediatric population in our setting and suggest some convenient solutions. Methods We carried out a prospective and descriptive study over 12 months in the pediatric surgery department of Fattouma Bourguiba University Hospital. Results One thousand four hundred twenty-six patients were scheduled for surgery at the pediatric surgery department, of whom 131 (9.2%) were canceled. Medical and anesthesia-related reasons accounted for 62.5% of all cancellations, followed by surgical reasons at 16%, organizational or administrative issues at 11.5%, and patient-related reasons at 10%. The most significant causes were upper respiratory tract infections (URTIs) in 36.6%, abnormal blood test results in 16%, and non-adherence to preoperative fasting in 9.2%. Conclusions The rate of pediatric elective surgery cancellations at Fattouma Bourguiba University Hospital was higher than the accepted average rate (5%). Therefore, to prevent these cancellations as much as possible, efforts should be made to promote children’s medical care, operation scheduling, and efficient institution resource utilization

Ischemic necrosis of the tongue following transoral neurosurgical procedure

Introduction: Postoperative, lingual swelling and necrosis are unusual complications that can lead to life-threatening airway obstruction. We report a case of bilateral ischemic necrosis of the tongue following transoral neurosurgical procedure. Observation: A Davis-Boyle mouth gag was used for tumor exposition and the operation lasted 8 h. At the end of the surgery, we noticed a bluish discoloration with a mild edema of the tongue. The patient had kept intubated in a monitored setting and intravenous steroids were administered. However, the edema increased and necrosis of the tongue appeared 72 h after the surgery. The patient underwent tracheotomy and the necrotic tissue was removed. More than 15 days passed before glossal engorgement resolved. Discussion: The etiology of tongue necrosis is likely related to tissue ischemia, secondary to venous or arterial obstruction. Prolonged use of the Davis-Boyle mouth gag may incur greater risk of ischemic necrosis of the tongue

Long-term clinical follow-up and molecular testing for diagnosis of the first Tunisian family with Alström syndrome.

Alström syndrome is a clinically complex disorder characterized by progressive degeneration of sensory functions, resulting in visual and audiological impairment as well as metabolic disturbances. It is caused by recessively inherited mutations in the ALMS1 gene, which codes for a centrosomal/basal body protein. The purpose of this study was to investigate the genetic and clinical features of two Tunisian affected siblings with Alström syndrome. Detailed clinical examinations were performed including complete ophthalmic examination, serial audiograms and several biochemical and hormonal blood tests. For the molecular study, first genomic DNA was isolated using a standard protocol. Then, linkage analysis with microsatellite markers was performed and DNA array was used to detect known mutations. Subsequently, all ALMS1 exons were simultaneously sequenced for one affected patient with the TaGSCAN targeted sequencing panel. Finally, segregation of the causal variant was performed by Sanger sequencing. Both affected siblings had cone rod dystrophy with impaired visual acuity, sensorineural hearing loss and truncal obesity. One affected individual showed insulin resistance without diabetes mellitus. Other clinical features including cardiac and pulmonary dysfunction, hypothyroidism, hyperlipidemia, acanthosis nigricans, renal and hepatic dysfunction were absent. Genetic analysis showed the presence of a homozygous splice site mutation (c.10388-2A \u3e G) in both affected siblings. Although Alström syndrome is relatively well characterized disease, this syndrome is probably misdiagnosed in Tunisia. Here, we describe the first report of Tunisian patients affected by this syndrome and carrying a homozygous ALMS1 mutation. The diagnosis was suspected after long-term clinical follow-up and confirmed by genetic testing. Eur J Med Genet 2016 Aug 12; 59(9):4

Isolated ureteral injury from multiple stab wounds: A case report

This is a case report about a 44-year-old woman who sustained multiple stab wounds, resulting in an isolated right ureteral injury. Despite a precise diagnosis from an urgent CT scan showing contrast material extravasation, the patient's stable vital signs allowed for a thorough surgical exploration, leading to an accurate diagnosis. Immediate surgical repair of the right ureter using an end-to-end anastomosis following precise surgical principles achieved complete restoration of the initial injuries. The case highlights the accuracy of CT scan assessment, the unreliability of hematuria in diagnosing ureteral injuries, and the need for a high index of suspicion during surgical exploration to avoid overlooking such cases