La Tunisie Médicale

Virtual Reality for Anxiety Reduction in Patients Undergoing Non-Surgical Cardiac Procedures: A Narrative Review

Siwar Belhaj Salem — 2026-10-11

Invasive cardiac procedures are a source of anxiety and discomfort for patients, often impacting their physical and mental wellbeing. While medications remain the standard care for anxiety management in these patients, numerous non-pharmacological alternatives like virtual reality have also been adopted to help manage the resulting distress. Virtual reality constitutes a novel technology that may help reduce the patients’ periprocedural anxiety and pain by providing distraction and relaxation as well as education about the procedures. Thus, we aimed to investigate the effectiveness of virtual reality in anxiety management during non-surgical cardiac procedures, including coronary angiography, cardiac catheterisation, catheter ablation for cardiac arrhythmias, and transcatheter valve implantation. We conducted a narrative review using the PubMed database that included 17 studies. After an in-depth analysis of these studies, we concluded that virtual reality is an efficient tool for increasing patients’ preoperative preparedness and education, lowering anxiety levels during the procedure and potentially reducing post- procedural stress. This review also highlights the limitations of the studies and future areas of research, illuminating the need for further studies and standard guidelines to address more profoundly the application of this technology in daily cardiac procedures.

Abstracts of the 2nd International Congress of Scientific Writing & the 51st National Medical Congress- STSM 2026

2026-10-11

5th International Conference on Contemporary Oncology Abstracts

2026-10-15

Prevalence of Ambulatory Hypertension, Hemodynamic Phenotypes, and Subclinical Myocardial Dysfunction After Coarctation of the Aorta Repair

Faten Yahia — 2026-10-11

Introduction: Arterial hypertension is the leading long-term complication after coarctation of the aorta (CoA) repair. Ambulatory blood pressure monitoring (ABPM) phenotyping combined with speckle-tracking echocardiography remains undercharacterized in pediatric and young adult cohorts, with no data from North Africa.
Aim: To describe the prevalence and hemodynamic phenotypes of ABPM-defined hypertension, evaluate subclinical myocardial dysfunction by global longitudinal strain (GLS), and identify independent predictors of ambulatory hypertension after CoA repair.
Methods: A cross-sectional study at CHU Sahloul, Sousse, Tunisia, included 30 patients aged 5 to 30 years after isolated CoA repair. ABPM was classified using age-appropriate guidelines. Speckle-tracking-derived GLS was assessed in all patients. Predictors of ABPM-defined hypertension were identified by multivariable logistic regression.
Results: ABPM-defined hypertension was identified in 13 patients (43.3%): sustained ambulatory hypertension in 11 (36.7%) and masked hypertension in 2 (6.7%). White-coat hypertension was absent. Left ventricular hypertrophy (LVH) was present in 7 patients (23.3%) and reduced
GLS in 8 (26.7%) despite universally preserved left ventricular ejection fraction (LVEF, mean 57.5 ± 3.1%). The peak isthmic Doppler gradient was the sole independent predictor of ABPM-defined hypertension (adjusted OR 1.16 per mmHg; 95% CI 1.03 to 1.31; p = 0.016).
Conclusion: ABPM reveals a substantial hypertension burden after CoA repair characterized by complete absence of white-coat hypertension. The peak isthmic Doppler gradient independently predicts ambulatory hypertension and should be systematically quantified at follow-up
echocardiography. Speckle-tracking echocardiography identifies subclinical myocardial dysfunction in patients with preserved LVEF.

Impact of Iron-Deficiency Anemia on HbA1c Measurement in Non-Diabetic Algerian Adults

Sabrine Deghima — 2026-10-11

Introduction-Aim: Glycated haemoglobin (HbA1c) is a widely used clinical marker for assessing glycaemic control in patients with diabetes. However, certain conditions may affect the reliability of this marker, anaemia, particularly iron deficiency anaemia, being a common source of
HbA1c variability. This study aimed to determine the total haemoglobin threshold below which HbA1c measurements become uninterpretable.
Methods: The study included 99 patients with iron deficiency anaemia, in whom three main parameters were measured: HbA1c, total haemoglobin and fructosamine. The population was stratified into three groups according to anaemia severity, and a correlation analysis was performed between HbA1c and fructosamine, a glycaemic marker independent of anaemia.
Results: Mean HbA1c was 5.90% ± 0.88 in moderate anaemia, 5.87% ± 0.72 in mild anaemia and 6.43% ± 1.12 in severe anaemia. These differences were not statistically significant (Kruskal–Wallis test, p = 0.34). A statistically significant positive correlation between HbA1c and fructosamine was observed in the moderate (ρ = 0.39; p = 0.007) and mild (ρ = 0.38; p = 0.017) anaemia groups, but not in the severe anaemia group (p = 0.503).
Conclusion: Our preliminary findings show that below a total haemoglobin threshold of 9 g/dL in men and 8 g/dL in women, HbA1c is no longer a reliable marker of glycaemic control, and that the use of alternative markers, such as fructosamine, represents a valuable alternative until iron
deficiency is corrected

Health insurance and medical deserts: The case of Morocco

Abdelati Zouine — 2026-10-11

Introduction: Universal health coverage is a key objective in Morocco. However, it faces significant imbalances in the distribution of resources. The study explores ways in which these imbalances can be addressed.
Methods: The study adopts a mixed-methods approach, combining quantitative analysis using principal component analysis with an examination of concentration, and qualitative analysis through a review of the legislation governing health insurance.
Results: The PCA reveals a strong correlation between the nine healthcare provision indicators (coefficients ranging from 0.804 to 0.992), with a KMO index of 0.709, confirming the suitability of the data. Two axes account for 96.37% of the total variance, one corresponding to the overall level
of healthcare provision and the other contrasting public and private provision. The factor map shows six under-resourced regions. At the provincial level, Gini indices >0.5 indicate severe inequalities in distribution, with all values exceeding the 0.5 threshold that characterises critical inequality.
Discussion: The Moroccan health insurance system has an equity objective but contains no explicit territorial provisions; governance is centralised and Article 1 prohibits any discrimination based on area of residence. Fiscal incentives for private investment in underserved areas are low (0.5% of tax expenditure in 2024). International approaches exist, but their implementation in Morocco faces technological, financial and governance obstacles.
Conclusions: There are multiple levers that health insurance can mobilise, starting with positive discrimination in favour of insured persons residing in these regions.

Demonstration of the antifungal activity of Lawsoniainermis(henna) on dermatophytes and yeasts of medical interest

Ismail Faiz — 2026-10-11

Lawsonia inermis (henna) is an ancestral plant long used by women in cosmetics, but it was also used as a topical treatment for some onychopathies and ringworm of the scalp. This led us to investigate in vitro the antifungal activity of this plant on the main fungi responsible for these conditions (dermatophytes and yeasts).
The objective of our study was to confirm or refute the antifungal effect of Lawsonia inermis on dermatophytes and yeasts. This is a prospective study including mycological samples from our laboratory with isolated species (Candida albicans, Candida glabrata, and Trichophyton rubrum),
which were inoculated on petri dishes with sterilized henna paste. The yeasts were insensitive to the henna paste, as evidenced by their growth on the paste itself. The isolated Trichophyton rubrum strains were sensitive to henna paste (with inhibition diameters ranging from 25 mm to 40
mm); however, some Trichophyton rubrum cultures were contaminated with molds (Penicillium spp). This involuntary contamination allowed us to identify the sensitivity profile of this mold to henna, revealing complete insensitivity. Henna did not show activity on the studied yeasts or isolated
mold; however, it would probably be effective against the Trichophyton rubrum, which is responsible for most onychomycosis and intertrigo.
Therefore, the traditional use of henna in these cases could be partly justified by our study. Thus, any mycological sampling should not be done on a Lawsonian pigmentation in order not to distort the final result.

Hepatitis A in Sfax,Tunisia, from 2000 to 2017: A prominent epidemiological shift among blood donors population

Saba Gargouri — 2026-10-11

Objective: To assess the evolution of the epidemiological pattern of HAV infection in Sfax through the determination of HAV seroprevalence in 2017 and the comparative analysis with data of 2000 and 2007.
Methods: A total of 378 blood donors sampled in 2017 were included. In line with the previous adopted methodology, blood donors belonged to three age groups: 18-20, 21-25 and 26-30 years and are originating from Sfax governorate (urban and rural areas) and different governorates
of South Tunisia. Total anti-HAV antibodies were assessed in serum samples. Comparative analysis between 2000, 2007 and 2017 was performed using SPSS version 20.0 Software.
Results: The overall HAV seroprevalence in 2017 was 65.1% with a significant increase with older age (50.8%, 65.9% and 78.6% in the 18-20, 21-25 and 26-30 years age groups, respectively). HAV seroprevalence was significantly lower in urban areas of Sfax than in rural settings and South Tunisia
(31%, 80.2% and 84.1%, respectively). In the age group 18-20 years, seroprevalence was 14.3%, 64.3% and 73.8% in Sfax’s urban areas, Sfax’s rural areas and South Tunisia, respectively. In Sfax’s urban areas, only 45.2% of blood donors in the age group 26-30 years had anti-HAV immunity. A significant decrease....( abstract truncated at 250 words).

Effect of consumer reconstitution practices on acetaminophen concentration in sachet formulations: Pilot study

Yessin Mokni — 2026-10-11

Background: Single-dose powder sachets are used to overcome solubility limitations of several actives such as acetaminophen. After reconstitution,residual deposits and sedimentation may reduce the delivered dose.
Objectives: Develop and validate a rapid assay for acetaminophen quantification in sachet preparations and evaluate consumer reconstitution practices to generate provisional, product-specific recommendations.
Methods: Prospective pilot study on four commercial sachet products. Twenty-eight volunteers (7 per product) simulated preparation and administration. Studied preparation variables were: reconstitution volume (mL) and stirring time (s). An aliquot of each preparation was analyzed by the validated chromatography (HPLC) method. Correlation coefficients between measured concentrations and preparation variables were calculated. Product-specific predictive models were generated for variables showing significant association. Optimal reconstitution conditions were estimated from these models.
Results: Inter-individual variability was large: SD(volume) = 27.76 mL; SD(stirring time) = 8.98 s. Recovered concentrations ranged from 59.4% to 99.7% of the predicted value; only 4/28 preparations reached ≥97.5% of expected concentration. Product-specific optimal conditions calculated were — Product 1: stir 37 s, volume 90 mL; Product 2: volume 178 mL, stir 7 s; Product 3: stir 11 s, volume 64 mL.
Conclusion: In this exploratory pilot, consumer reconstitution of acetaminophen sachets produced substantial variability and frequent under-delivery. The validated HPLC assay enabled derivation of provisional, product-specific reconstitution parameters.

Neutrophil-to-Lymphocyte Ratio as a Predictor of Complicated Acute Appendicitis: A Multicenter Retrospective Study in Tunisia

Amina Chaka — 2026-10-11

Background: Distinguishing complicated from uncomplicated acute appendicitis (AA) at admission remains a clinical challenge with major therapeutic implications. The Neutrophil-to-Lymphocyte Ratio (NLR) has emerged as a promising composite biomarker of systemic inflammatory stress.
Objectives: To evaluate the diagnostic performance of NLR in predicting complicated acute appendicitis (CAA) and determine its optimal cut-off value in a Tunisian surgical population.
Methods: A multicenter retrospective observational study was conducted at the General Surgery departments of CHU Fattouma Bourguiba (Monastir) and CHU Habib Bourguiba (Sfax) over 18 months (June 2024 – December 2025). A total of 380 patients aged ≥16 years who underwent surgery for confirmed AA were included. NLR, PLR, CRP, and WBC were measured at admission. ROC curve analysis was used to assess discriminating performance and determine the optimal cut-off using the Youden index.
Results: Of 380 patients (male-to-female ratio: 1.17; median age: 30 years), 178 (46%) had CAA. NLR was significantly higher in the CAA group (6.2 ± 3.3 vs. 3.7 ± 1.5; p<0.001). ROC analysis revealed an AUROC of 0.75 (95% CI: 0.70–0.80...( abstract truncated at 250 words).

Fertility Disorders in Women with Rheumatoid Arthritis: Proportion and Associated Factors

Leila Rouached — 2026-10-11

Objective: To determine the proportion of fertility disorders in non-menopausal women with rheumatoid arthritis (RA) and to identify associated factors.
Methods: We conducted a cross-sectional observational study including non-menopausal women aged ≥18 years diagnosed with RA. Sociodemographic characteristics, disease-related variables, and treatments were collected. Prolonged time to conception was defined as a time
to conception exceeding 12 months. Infertility was defined as the absence of pregnancy after 12 months of unprotected and regular intercourse.
Results: Fifty women were included (mean age: 39.1 ± 6.9 years). The mean age at RA diagnosis was 31.1 ± 8.7 years, with a median disease duration of 8.5 years. RA was immunopositive in 27%, and erosive in 80%. Extra-articular manifestations were observed in 34% of patients, predominantly sicca symptoms (28%). Fertility disorders were identified in 31% of patients: 10% had a prolonged time to conception and 21% had infertility, which was primary in 80% of cases. Pregnancy loss occurred in 48% of women with prior pregnancies. Receiver operating characteristic (ROC) analysis indicated that RA duration >6 years was significantly associated with fertility disorders (AUC =0.692, p = 0.049), with a sensitivity of 84.2% and specificity of 55.2%. No significant associations were observed between fertility disorders and disease activity or current treatments.
Conclusion: Fertility disorders are common in women with RA. Disease duration exceeding six years emerged as a significant associated factor. Early disease control and systematic reproductive counseling should be integral components of RA management in women of childbearing age.

Knowledge and Attitudes Toward Electronic Cigarettes and Prevalence of Electronic Cigarette Use Among Medical Students in Casablanca, Morocco: A Cross-Sectional Study

Soukaina Lyazidi — 2026-10-11

Introduction: The use of electronic cigarettes is increasing worldwide, especially among adolescents and young adults. Medical students attitudes are likely unique and may be important to explore.
Aim : The objectives of this study were to describe Moroccan medical students knowledge and attitudes toward electronic cigarettes, to estimate the prevalence of electronic cigarettes use among them, and to identify factors associated with this practice.
Methods: A cross-sectional study was conducted during the academic year 2020-2021, including all medical students enrolled at the Faculty of Medicine and Pharmacy of Casablanca.
Results: Among the 491 participants, the mean age was 21.0±2.3 years and the female/male ratio was 1.94. The prevalence of lifetime electronic cigarettes use was 20.2% [16.6%; 23.7%]. Being a male (p<0.001), smoking tobacco (p<0.001), having a family member or close friend who uses
e-cigarettes (p<0.001), and having a family member or close friend who uses traditional cigarettes (p<0.001) were significantly associated with electronic cigarettes use. Electronic cigarettes use was significantly associated with beliefs that they are an effective way to quit smoking (p=0.025), that they are more effective than nicotine replacement therapy (p=0.009), that they do not contain carcinogens (p=0.025), that vaping is less harmful than smoking tobacco (p=0.009), and that the consequences of vaping are less serious than smoking tobacco (p=0.033).
Conclusion : Incorporating courses on the dangers of e-cigarettes into the medical curriculum may improve students cessation outcomes and their competencies in tobacco and e-cigarette cessation counseling.

Prognostic value of the neutrophil-to-lymphocyte ratio in critically ill patients with severe pneumonia

Ines Sdiri — 2026-10-11

Introduction : Community-acquired pneumonia (CAP) is one of the main reasons for admission to intensive care. Several studies have suggested the potential role of the neutrophil-to-lymphocyte ratio (NLR) in risk stratification and prognosis prediction in septic patients. Our objective was to evaluate the prognostic value of NLR on admission to intensive care in patients hospitalized for CAP.
Methods : We conducted a prospective, single-center, observational cohort study in the medical intensive care unit over a six-month period, from July 2024 to December 2024. We included patients over 18 years of age admitted to intensive care for CAP.
Results : We included 126 patients with a median age of 68 years and a gender ratio of 1.13. The main comorbidities were diabetes (48.8%), hypertension (47.6%), and dyslipidemia (41.2%). The APACHE II and SAPS II scores were 7.7 ± 4.4 and 24 ± 7.4 points, respectively. Invasive mechanical ventilation was indicated in 30 patients (23.8%). Thirty-one patients (24.6%) were in shock and 31 patients (24.6%) had ARDS. The mortality rate was 46% with a median length of stay of 5 days. The median NLR was 8.85. An NLR > 9 was associated with mortality (p < 10⁻³) with an AUC = 0.69, sensitivity = 62%, and specificity = 64%. It was associated with an increased risk of shock (p=0.03), acute respiratory distress syndrome (p=0.01) and acute renal failure (p=0.04).
Conclusion : NLR is a relevant biomarker that can determine the short-term prognosis in patients hospitalized for CAP.

Clinicopathological and Prognostic Features of Anaplastic Thyroid Carcinoma: A Tunisian Study of 50 Cases

Alia Methnani — 2026-10-11

Introduction: Anaplastic thyroid carcinoma (ATC) is an exceptionally rare and aggressive malignancy.
Aim: This study aimed to evaluate the clinical features, therapeutic outcomes, and prognostic factors within a Tunisian multicenter cohort.
Methods: We conducted a retrospective multicenter analysis of 50 ATC cases treated between 1998 and 2021 at two tertiary referral centers in Tunisia.
Results: The mean age was 62 years with a female predominance (M/F ratio 0.61). The most common presenting symptom was rapid enlargement of a long-standing goiter (80%). At diagnosis, the mean tumor size was 62 mm, and all patients presented with stage IV disease: IVA (n=1), IVB (n=23), and IVC (n=26). Therapeutic interventions included tracheostomy (n=29), surgical resection (n=21, with R0/R1 achieved in 16), and palliative radiotherapy (n=21). Only five patients received full multimodal therapy. Univariate analysis identified slow symptom onset, early stages (IVA/IVB), absence of distant metastasis, R0/R1 resection, and multimodal treatment as significant factors for improved survival. Conversely, obesity and blood group B were associated with poorer outcomes. The mean overall survival was 3.85 months, and no patient was alive at the last follow-up.
Conclusion: ATC is associated with a particularly unfavourable prognosis, with an overall survival of less than one year. While multimodal management appears to marginally improve survival, early diagnosis and the integration of targeted therapies and immunotherapies are essential to change the therapeutic landscape.

Mapping the Mobile Health Applications Landscape: A Cluster-Based Systematic Review

Fatima Ezzahra Yakoubi — 2026-10-11

Introduction-Aim: Mobile health applications (MHAs) have become essential components of modern healthcare systems worldwide. Despite their growing adoption, a comprehensive global synthesis integrating clinical outcomes, adoption factors, and regional distribution of MHA research remains lacking. This review provides a systematic, cluster-based global perspective on MHAs by examining research trends, typologies, and regional disparities across peer-reviewed literature published from 2015 to 2023.
Methods: A systematic literature review was conducted following PRISMA guidelines. Articles were retrieved from Scopus, Web of Science, and PubMed using search terms including "mobile health," "mHealth," and "mobile health applications," restricted to peer-reviewed English-language
publications. After screening 1,430 identified records, 229 studies were included in the final synthesis. Thematic cluster analysis was performed using VOSviewer to identify and visualize key research clusters.
Results: Three main thematic clusters were identified: (1) Clinical interventions and outcomes, demonstrating positive effects of MHAs on chronic disease management, patient adherence, and healthcare costs, notably in diabetes, hypertension, and asthma; (2) Psychological and social factors, highlighting the critical role of user-centered design, perceived usefulness (TAM), and social influence (UTAUT) in driving MHA adoption; and (3) Technology and development, addressing interoperability challenges, data security concerns, and device accessibility. MHA typologies span clinical diagnostics, disease management, health promotion, telemedicine, and clinical reference tools. The United States leads in research output, followed by Europe and Asia, while Latin America and Africa remain significantly underrepresented.
Conclusion: MHAs hold significant potential to bridge global healthcare gaps, particularly in resource-limited settings. Standardizing clinical trial protocols, improving user-centered design, strengthening data security, and fostering research in underrepresented regions are critical priorities for researchers, developers, and policymakers advancing equitable healthcare delivery through mobile technologies.

Simulation and Structured Debriefing to Teach Breaking Bad News in Pediatric Care

Abir Boussetta — 2026-10-11

Introduction: Breaking bad news is an essential medical skill and is particularly challenging in pediatrics. Simulation combined with structured debriefing is an educational strategy for developing communication skills.
Aim : To describe an educational intervention based on role-play and structured debriefing, and to explore its perceived impact on medical students’ communication skills when breaking the news of end-stage chronic kidney disease in pediatric patients.
Methods: A single-center descriptive study was conducted during the 2025–2026 academic year among 42 second-year medical students(DCEM2). Students participated in a structured teaching session comprising a theoretical introduction, role-play simulation, and structured
debriefing. Evaluation was based on a satisfaction questionnaire, pre/post-intervention self-assessment, qualitative analysis of students’ comments, and a structured observational assessment of the performance of the three students who played the role of the physician, using a
13-domain competency grid scored from 0 to 2.
Results: All 42 students participated in the entire educational intervention and completed the questionnaires, correspond ..( abstract truncated at 250 words).

Impact of MCQ-Writing Training on the Psychometric Quality of a Surgery Examination: A Before-and-After Study

Baha Khlifa — 2026-10-11

Introduction: Summative assessment plays a central role in medical education and requires valid and reliable tools. The psychometric quality of multiple-choice questions (MCQs) largely depends on their design.
Objective: To assess the impact of pedagogical training in MCQ writing on the psychometric properties of a surgery examination at the Faculty of Medicine of Sousse.
Methods: This was a pre-experimental before-and-after study comparing two successive sessions of the same examination, conducted in 2024 and 2025. A total of 174 students, including 96 in period 1 and 78 in period 2, as well as 180 items, were analyzed. The assessed parameters
included the difficulty index, discrimination index, effective coefficient, response categories, and global test indicators, particularly Cronbach’s alpha and measurement error.
Results: Overall student performance, in terms of mean score and success rate, was comparable between the two periods (p = 0.774). However, the median discrimination index significantly improved, increasing from 28.27 to 40% (p = 0.003). The proportion of items with excellent
discrimination increased from 23.3 to 50% (p < 0.001). Cronbach’s alpha increased from 0.87 to 0.93, while the difficulty index remained stable.
Conclusion: Pedagogical training improved the psychometric quality of the examination without changing overall student performance, highlighting the value of an institutional approach based on continuous faculty training and regular psychometric analysis of examinations.

Assessing the Feasibility and Acceptability of Direct Observation of Procedural Skills (DOPS) in Internal Medicine: A Cross-Sectional Study

Mariem Essouri — 2026-10-11

Introduction: The assessment of clinical competencies is a fundamental component of competency-based medical education. Direct Observation of Procedural Skills (DOPS) is a workplace-based assessment method that evaluates learners’ performance during real clinical procedures while promoting a formative approach through immediate feedback.

Aim: To assess the feasibility and acceptability of DOPS among medical students and clinical teachers in a university Internal Medicine department.

Methods: We conducted a 15-week observational cross-sectional study involving 22 third-year medical students (DCEM3) assigned to the Internal Medicine department of Razi Hospital. The assessed procedure was the pathergy test. The evaluation covered eight domains: explanation of the indication and procedure, obtaining consent, preparation, aseptic technique, technical skills, communication, professionalism, and post-procedure management.

Results: The mean duration of a DOPS session was 14 minutes, including observation, documentation, and feedback. Competency levels were globally satisfactory in several domains, particularly in explaining the indication, aseptic technique, communication, and technical skills. Both students and teachers expressed good acceptance of the method and emphasized the value of direct observation and immediate feedback.

Conclusion: DOPS appears to be a feasible, well-accepted, and relevant method for assessing clinical competencies in Internal Medicine. Its progressive integration into clinical training programs may strengthen competency-based education and promote a culture of feedback.

The Faculty of Medicine of Tunis and the One Health Approach: From Academic Integration to Institutional Engagement

Rym Baati — 2026-10-11