Spectrum of acute hepatitis and its clinical outcome in a central region in Tunisia

Introduction: given the lack of studies on acute hepatitis (AH) in Tunisia, we carried out this study to find the etiological spectrum and clinical profile of AH and to investigate the impact of viral etiology on the outcomes of AH. Methods: retrospective descriptive study collecting all patients with AH from 2010 to 2017. The data were compared between two groups (viral AH and non-viral AH). Results: one hundred and three patient´s files were included. The average age of our patients was 30.15 years. An etiology was found in 92 patients (89.3%). The viral etiology was found in 70 patients (76.1%). Hepatitis A virus (HAV), Hepatitis A virus (HBV), Hepatitis A virus (HCV) and cytomegalovirus (CMV) were in the cause in 52, 16, 1 and 1 patient respectively. Elsewhere, it was toxic hepatitis in 10 patients (10.9%) including 7 of drug-related AH. Budd-Chiari syndrome and autoimmune hepatitis with acute onset were reported in 3 (3.3%) and 7 (7.6%) patients, respectively. Patients with viral AH were younger than those with non-viral AH (p = 10-³). There was more recourse to hospitalization for non-viral AH. Patients with viral AH had a higher mean ALT level than those with non-viral AH. The liver damage was more severe in the non-viral AH group with lower PT. There was more severe form, more transition to chronicity and more deaths in the non-viral AH group. Conclusion: the results found in our study concerning the distribution of the etiologies of AH as well as their evolutionary aspects are consistent with the data in the literature

A meta model for mining processes from email data

International audienceSignificant research work has been conducted in the area of process mining leading to mature solutions for discovering knowledge from structured process event logs analysis. Recently, there were several initiatives to extend the scope of these analysis to consider heterogeneous and unstructured data sources. More precisely, email analysis has attracted much attention as emailing system is considered as the principal channel to support the execution of business processes. However, existing initiatives didn’t formalize the relationship between emailing systems and business process elements. As a result, they target to discover business processes limited to the activity perspective. In this paper, we first propose a meta model to specify what kind of process knowledge we can discover from emails. We define by this way a research roadmap for an effective multi-perspective process discovery from emails. This metamodel is proved through a concrete case study related to "hiring", "patent application", and "paper submission" business processes. In addition, we highlight the limitations of current process mining techniques in the discovery of different process perspectives

Date flesh: Chemical composition and characteristics of the dietary fibre

The date by-products of two date palm (Phoenix dactylifera L.) cultivars, Deglet-Nour and Allig, from the Degach region (Tunisia), were analysed for their main chemical composition. Studies were also conducted on the physicochemical properties (colour, water and oil-holding capacity and theological behaviour) of dietary fibre (DF) extracted from date flesh. The following values (on a dry matter basis: DM) were obtained for fleshes of Deglet-Nour and Allig cultivars, respectively: sucrose 52.7% and 13.9%, glucose 13.7% and 29.9%, fructose 12.6% and 29.0%, total dietary fibre 14.4% and 18.4%, protein 2.1% and 3%, ash 2.5% and 2.52%. Insoluble DF, the major fraction of total DF, constituted 9.19-11.7% DM for Deglet-Nour and Allig, respectively. The elaboration of DF concentrates from date fleshes was characterised by an extraction yield of 67%. The chemical composition of these DF concentrates showed high total DF contents (between 88% and 92.4% DM) and low protein and ash contents (8.98-9.12% and 2.0-2.1% DM, respectively). The DF concentrates showed a high water-holding capacity (similar to 15.5 g water/g sample) and oil-holding capacity (similar to 9.7 g oil/g sample),and pseudoplasticity behaviour of their suspensions. Thus, date DF concentrates may not only be an excellent source of DF but an ingredient for the food industry. (c) 2008 Elsevier Ltd. All rights reserved

Enhancing proficiency in ascites puncture through procedural simulation: an audit type study investigating medium-term skill retention

Abstract Introduction Medical simulation has become an essential teaching method for all health professionals. It not only allows to acquire technical and non-technical knowledge, but also helps the maintenance of acquired knowledge in the medium and long term. Ascites puncture is part of the basic technical procedures learned by medical students during their internship. Objectives To evaluate the role of simulation-based learning of ascites puncture on the improvement of theoretical knowledge and maintenance of skills at 3 months. Methods We conducted an audit type study with two cycles of data collection at the simulation center at the Faculty of Medicine of Sousse between November 2020 and June 2021. We included learners in their third year of medical studies who had a hospital internship in the gastroenterology department at Sahloul Hospital in Sousse. All learners attended the initial simulation session on ascites fluid puncture. Thereafter, they were free to accept or refuse participation in the evaluation session that was scheduled after 3 months, depending on their availability. Results Forty learners participated in the procedural simulation of the ascites fluid puncture technique. Thirty-four (85%) were female and six (5%) were male. In our study, we showed that following procedural simulation training of ascites puncture, there was a significant improvement in the theoretical knowledge of the learners (p < 0.000). Objective assessment of technical skills after 3 months showed the benefit of performance maintenance (p < 0.000). Conclusion Our study confirmed the benefit of simulation-based learning on the improvement of theoretical knowledge and the maintenance of technical performance in the medium term

Exploring work productivity loss in patients with inflammatory bowel disease

Aim: We aimed in this study to evaluate the impact of inflammatory bowel disease (IBD) on patients’ professional life and to determine predictors of severe work productivity loss (WPL). Materials & methods: A cross sectional study including patients with a confirmed diagnosis of IBD. Work productivity was evaluated with the work productivity and activity impairment score. Results: Severe absenteeism and WPL were found in respectively 7 (5.1%) and 54 (39.1%) patients. In multivariate analysis, the following features were found to be independently associated with severe WPL: penetrating Crohn’s disease (p: 0.001, OR: 6), anemia (p: 0.031, OR: 3.23), diarrhea (p < 0.001, OR: 11.23) and a secondary level of education (p: 0.003, OR: 1.95). Conclusion: Our results show that IBD have a substantial effect on patients’ professional life

Predictive factors of recurrence in spontaneous bacterial peritonitis in Tunisian patients with cirrhosis

Introduction: Recurrent spontaneous bacterial peritonitis (SBP) in patients with cirrhosis is associated with poor prognosis. Aim: To assess the prevalence and the risk factors for recurrence and to evaluate its impact on the prognosis. Materials & methods: We conducted a retrospective study including patients with cirrhosis having a first episode of SBP. Results: A recurrence of SBP was identified in 43.4% of the patients who survived after a first episode of SBP. The mean time to onset of the first SBP recurrence from the first episode was 32 days. Recurrence factors were endoscopic hypertensive signs, a positive ascites culture, diarrhea and the MELD score. Conclusion: There was no impact on survival of recurrent SBP compared with the first SBP episode

Multi-Organ Involvement of Immunoglobulin G4-Related Disease

Immunoglobulin G4-related disease (IgG4-RD) is a fibroinflammatory condition of unknown etiology, with presumed autoimmune mechanisms. It is characterized by high levels of IgG4 and variable clinical manifestations. It can involve one or multiple organs. Herein, we reported the case of a 62-year-old man with three organs involvement. He initially presented with recurrent jaundice. Laboratory analysis revealed cholestasis, high gamma-globulin levels, renal failure, and proteinuria. Abdominal Magnetic Resonance Imaging (MRI) showed segmental strictures of the left intrahepatic bile ducts and the wirsung duct with an increased volume of the pancreas and diffuse bilateral enlargement of the kidneys. Laboratory tests revealed high IgG4 levels (770 mg/dL). Based on the biological and radiological findings, we have suggested the diagnosis of systemic IgG4-related disease involving bile ducts, the pancreas, and probably the kidneys. Renal biopsy revealed lymphoplasmacytic infiltrate and fibrosis, but no IgG4-positive cell. The patient received corticosteroid therapy with a complete resolution of all symptoms and a rapid normalization of all blood tests. The present case underlines the complexity of IgG4-RD because of its variable clinical presentation. The diagnosis is challenging and should be carefully assessed for possible multi-organ involvement