Flexible bronchoscopy contribution in the approach of diagnosis and treatment of children’s respiratory diseases: the experience of a unique pediatric unit in Tunisia

Objective: Our study aimed at assessing the role of flexible bronchoscopy (FB) in improving diagnosis and management of children’s respiratory conditions in the pediatric unit of FB, newly created and unique in Tunisia.Methods: Retrospective study including all the FB achieved in our pediatric unit from 2009 to 2014.Results: We performed 365 FB in 333 patients aged 46 months on average (1 month - 15 years), often under conscious anesthesia (81.6%). FB was performed for diagnostic purposes in 341 cases and for therapeutic purposes in 24 cases. Eight anatomical abnormalities were revealed in 22 patients. An intraluminal bronchial obstruction was found in 71 FB, mainly due to a foreign body (n=36). A vascular anomaly was responsible for nine cases out of 17 extraluminal obstructions. Airways malacia was observed in 60 FB. Bronchoalveolar lavage was performed in 196 cases. It was determinant in 43.9% of the cases. FB was of great diagnostic value in 74.8% of the cases. It influenced the management of the patients in 58% of the cases. The FB for therapeutic purposes was beneficial in all cases. Few complications occurred (5.5%).Conclusion: FB is a safe tool providing precious diagnostic and/or therapeutic help for the clinician.Keywords: Flexible bronchoscopy, child, bronchoalveolar lavage, foreign body aspiration, pulmonary alveolar proteinosi

Flexible bronchoscopy contribution in the approach of diagnosis and treatment of children\u2019s respiratory diseases: the experience of a unique pediatric unit in Tunisia.

Objective: Our study aimed at assessing the role of flexible bronchoscopy (FB) in improving diagnosis and management of children\u2019s respiratory conditions in the pediatric unit of FB, newly created and unique in Tunisia. Methods: Retrospective study including all the FB achieved in our pediatric unit from 2009 to 2014. Results: We performed 365 FB in 333 patients aged 46 months on average (1 month - 15 years), often under conscious anesthesia (81.6%). FB was performed for diagnostic purposes in 341 cases and for therapeutic purposes in 24 cases. Eight anatomical abnormalities were revealed in 22 patients. An intraluminal bronchial obstruction was found in 71 FB, mainly due to a foreign body (n=36). A vascular anomaly was responsible for nine cases out of 17 extraluminal obstructions. Airways malacia was observed in 60 FB. Bronchoalveolar lavage was performed in 196 cases. It was determinant in 43.9% of the cases. FB was of great diagnostic value in 74.8% of the cases. It influenced the management of the patients in 58% of the cases. The FB for therapeutic purposes was beneficial in all cases. Few complications occurred (5.5%). Conclusion: FB is a safe tool providing precious diagnostic and/or therapeutic help for the clinician. Keywords

Transition Pathway Toward Agroecology in Agroforestry Systems: Case of Kesra

The mountain of Kesra is located at an altitude of 1245 m with a very uneven relief. It belongs to the upper semi-arid bioclimatic stage. The range of soils is very diverse due to the extreme variability of substrates, climates, and plant species. Despite the richness of natural resources and heritage, and the ancestral know-how of local populations, the region of Kesra, continues to suffer from economic and social underdevelopment. Standard applications, which do not take into account the specificities of each area, often do not achieve the objectives of ecodevelopment and sustainability. The application of a holistic agroecological transition approach in this rural mountain area requires an inclusive co-design which takes into consideration the socio-ecological context (Natural resources use, agricultural practices, agroforestry, etc.). So, the main objective was to define and build context-specific agroecological transition pathways throw a solid methodology which combines literature review, consultation, and focus group discussions. The visioning approach was conducted with 12 farmers from the community to reflect on the state of agriculture in Kesra and to identify a desirable future of agriculture in 10 years (2022-2032) from their own perspective. This vision was discussed and debated referred to the 13 principals of agroecology. The AE transition pathway identified in Kesra suggests an emphasis on the diversification of local and natural based products to insure synergies between system components as a basis of a swift transition. The resulting impact pathway promotes increasing resilience to market and climate change, economic autonomy, diversifying market, and promotion of local products. Based on this approach and other research activities a set of actions will be executed during 2023 and 2024 to monitor the co-designed transition pathways and to scaling-up the agroecological transition in the mountainous areas like Kesra

Bivariate analysis of SSI’s risk factors: Chi-squared test for nominal variables, Student’s t-test for continuous variables with normal distributions, Mann-Whitney U test for continuous variables with skewed distributions.

Bivariate analysis of SSI’s risk factors: Chi-squared test for nominal variables, Student’s t-test for continuous variables with normal distributions, Mann-Whitney U test for continuous variables with skewed distributions.</p

Consort checklist.

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Informed consent form.

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Comparison of wound healing disturbance after coated and non-coated suturing in univariate analysis.

Comparison of wound healing disturbance after coated and non-coated suturing in univariate analysis.</p

Multivariate logistic regression analysis.

Multivariate logistic regression analysis.</p

CONSORT 2010 flow diagram.

CONSORT 2010 flow diagram.</p

Study protocol.

(DOCX)</p