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Background: Influenza infection is a highly contagious viral disease. It may cause several nosocomial outbreaks. This study aimed to evaluate the knowledge and attitudes of healthcare workers (HCWs) about influenza vaccination and to identify factors associated with the uptake of influenza vaccination., Methods: We conducted a cross-sectional study over 5 months between November 2021 and March 2022. Data was collected using an anonymous self-administered questionnaire. We included all HCWs at Taher Sfar University Hospital who were willing to participate in the study., Results: A total of 395 HCWs were included. They were mainly women (78.7%) with an average age of 27 years. The medical personnel was the largest group (67.8%). Most respondents considered the vaccination to be optional and knew that it should be renewed every year, but 97.5% of them judged the efficacy of the vaccine to be low. The influenza vaccination uptake was only 20.2%. The main reasons for accepting vaccination were to protect patients and families. However, misconceptions about the severity and the risk of influenza and the belief that barrier measures were sufficient to prevent infection were the main causes of avoiding vaccination. The factors associated with adherence to vaccination were being a medical professional, old age, longer professional experience, and considering vaccination to be mandatory for HCWs., Conclusion: Our study showed a low adherence to influenza vaccination with misconceptions about vaccine efficacy and safety. More efforts are needed to improve the knowledge of HCW about the vaccine and boost the adherence rates., (Copyright © 2024. Published by Elsevier B.V.)

Epididymal tuberculosis is rare and often presents diagnostic difficulties. It may be indicative of a disseminated form of the infection, which is the case of our patient. A 19-year-old man, with no past medical history, was admitted for a swollen painful left scrotum that had been evolving for 8 months. He had undergone an orchiectomy and the anatomopathological examination was consistent with epididymal tuberculosis. The radiological investigations had revealed other localizations of the infection: lymphatic, pulmonary, parietal and osteoarticular tuberculosis. Anti-tuberculosis therapy was introduced. However, in the 4 th month of treatment, the patient developed seizures. A cerebral magnetic resonance imaging was practiced, concluding to cerebral tuberculomas. Anti-tuberculosis treatment was continued associated to an anticonvulsant with a favourable outcome. The originality of our observation resides in the mode of revelation of a disseminated paucisymptomatic tuberculosis, by an epididymal localization, in an immunocompetent patient., Competing Interests: Les auteurs ne déclarent aucun conflit d´intérêts., (Copyright: Rebeh Bougossa et al.)

Introduction: Self-medication of antibiotics among children is a very common problem in Tunisia. Its prevalence isn't well established. The aims of this study are to evaluate parents' knowledge concerning antibiotic use, and identify the factors associated with this problem., Patients and Methods: We conducted a cross-sectional study over a one year period (between August 2019 and July 2020). Data collection was performed using a questionnaire guided interview. We included parents of children consulting or hospitalized in the pediatric department of the university hospital Taher Sfar in Mahdia., Results: A total of 354 parents were included with an average age of 36.4±9.2 years. The average knowledge score was 2±1.3 points. In fact, 61.6% of the parents had poor knowledge about antibiotics. The frequency of non-prescription antibiotics use among children was 20.6%. Amoxicillin was the most used antibiotic (72.6%). Sore throat, important fever and flu-like symptoms were the main symptoms justifying non-prescription antibiotic use among our pediatric population in 60.3%, 34.2% and 23.3% of cases respectively. The main reason of self-medication was the fact that the same antibiotic was once prescribed to treat the same symptoms (58.9%). The used antibiotic came from an old prescription for the same child in 57.5% of the cases and was recommended by the pharmacist in 39.7% of the cases. After multivariate analysis, the factors associated with parental self-medication with antibiotics were: the advanced parent's age, the ability to name an antibiotic and knowledge's score>2., Conclusion: Our study confirmed that parental knowledge about antibiotic use is low. In fact, the government should from one hand, organize antibiotic delivery and prohibit off the counter sells and in the other hand promote the education of the public through different procedures to stop this major health problem., (Copyright © 2021 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.)

Background: Neuro-invasive disease is the most dreaded complication of West Nile virus infection. We report the case of an immunocompetent patient who developed a meningeal syndrome associated with cerebellar ataxia, facial diplegia and hemiparesis caused by West Nile virus infection with a favourable outcome., Observation: A 42-year-old man was admitted for a febrile meningeal syndrome and confusion associated with cerebellar ataxia. The patient had developed facial diplegia, left hemiparesis with worsening cerebellar syndrome. He was diagnosed with neuro-invasive West Nile virus infection given the positive West Nile virus serologies in serum and cerebrospinal fluid as well as West Nile virus polymerase chain reaction in serum and urine. The outcome was favourable., Conclusion: Because of the increasing prevalence of West Nile virus, this infection should be suspected in the event of atypical neurological manifestations even in immunocompetent patients., (Copyright © 2022 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.)

Introduction: Necrotising otitis externa (NOE) is a rare infection of the ear canal with frequent bone erosion. This study's objective is to describe the different features of NOE as well as its management in an ear-nose-throat department. We also tried to identify the particularities of the fungal infection., Patients and Methods: It is an observational cohort that included all the patients hospitalised for the management of NOE. The study was carried out in the ear-nose-throat Department of Mahdia University Hospital in Tunisia between January 2006 and december 2019., Results: A total of 40 patients were included. The mean age was 65 ± 12.9 years and the sex ratio was 0.9. Ninety percent of the patients included were diabetics. The most common signs found were oedema of the external canal (97.5%) and auricular discharge (92.5%). The main pathogen isolated was Pseudomonas aeruginosa (61.7%). Fungi were isolated in 9 cases (26.47%). Computed tomography was performed for 32 patients (80%). Bone erosion was seen in 26 cases (81.3%). The main complications were cerebral venous thrombosis, retropharyngeal abscess and cerebral empyema. Thirty one patients received only antibiotics, 2 received only antifungal treatment, and 7 received both antibiotics and antifungal treatment. All patients had a favorable outcome. Univariate analysis showed a higher median erythrocyte sedimentation rate was associated with fungal infections. No other differences were noted., Conclusion: Our management protocol seems to be efficient since all patients had initial favorable outcome. A higher median erythrocyte sedimentation rate was associated with fungal infections., Competing Interests: The authors have no conflicts of interest relevant to this manuscript to disclose., (© 2020 PLA General Hospital Department of Otolaryngology Head and Neck Surgery. Production and hosting by Elsevier (Singapore) Pte Ltd.)

Betulinic acid (BA), a pentacyclic triterpenoid, is a very promising therapeutic drug with varied medicinal properties but it has low water solubility and consequentially low bioavailability. Cyclic β-(1→3),(1→6)-glucans (CBG), microbial cyclooligosaccharides produced by Bradyrhizobium japonicum ATCC 10324 having a cavity structure and good solubility in water have been tested for their ability to encapsulate betulinic acid and drug-binding interactions of CBG and BA were studied. First, in silico approach was employed to study the scope of any interaction between the CBG and BA. Then, the cyclic glucan-betulinic acid complexes were prepared in three compositions of 1:1, 1:2 and 1:3 CBG:BA. The complexes were analysed using UV-VIS spectroscopy, IR spectroscopy, powder XRD, differential scanning calorimetry (DSC) and thermogravimetric analysis (TGA) to confirm the computational results and consequently the encapsulation efficiency was found to be 9.53%., (Copyright © 2017. Published by Elsevier B.V.)

Background: Coronary artery disease (CAD) is the leading cause of death and disability worldwide. Lipoprotein associated phospholipase A 2 (Lp-PLA 2 ) is an emerging biomarker for inflammation that has shown association with CAD. Its significance in the Asian Indian population is not clearly known. We sought to compare the possible association of various biomarkers of atherosclerosis along with Lp-PLA 2 , in symptomatic individuals with CAD vs. healthy controls in Asian South-Indians., Methods: We conducted a cross-sectional case control study at three centers in a South Indian population. A total of 100 CAD patients with acute coronary syndrome (ACS), 100 age and gender matched healthy controls participated, of which, 166 subjects or 83 case-control pairs with complete data for both participants were identified for the statistical analysis. Lp-PLA 2 concentration and activity were measured using PLAC test and PLAC activity assay respectively (diaDexus Inc., San Francisco, CA, USA), while all other parameters were measured using standard commercially available kits., Results: We enrolled a total of 200 subjects (mean age 50.7±9.6 years, 87.5% males). A total of 83 subjects completed the study in the CAD group (mean age 51 ±8.9 years, 85% males) and 83 subjects in the control group (mean age 50±8.9 years, 86.5% males). In the CAD group, Lp-PLA 2 concentration positively correlated with TC (ρ=0.19, P=0.02), non-HDL-C (ρ=0.20, P=0.02), Lp-PLA 2 activity (ρ=0.27, P=0.001) and Lp(a) (r=0.25, P=0.02). Lp-PLA 2 activity correlated positively with TC (ρ=0.28, P=0.001), LDL-C (ρ=0.30, P<0.001), non-HDL-C (ρ=0.35, P<0.001), ApoB (ρ=0.35, P<0.001) and negatively correlated to HDL-C (ρ=-0.24, P=0.004). Cox proportionality hazards model revealed Lp-PLA 2 concentration (β=0.006, SE =0.002, P=0.009) to have positive association with the event of CAD, while negative association was observed for ApoA1 (β=-0.06, SE =0.02, P=0.001). ROC analysis revealed that the highest quartile of Lp-PLA 2 concentration to have area under curve (AUC) of 0.80 (95% CI, 0.65-0.9; P<0.001) with cut off value of >427 ng/mL and ApoA1 with AUC of 0.78 (95% CI, 0.70-0.85; P<0.001) with cut off value of ≤129.6 mg/dL with the optimum balance of sensitivity and specificity., Conclusions: In this study population, circulating plasma Lp-PLA 2 was found to be elevated in CAD group. ApoA1 showed negative association and Lp-PLA 2 concentration showed positive association with risk for CAD. In the highest quartile, Lp-PLA 2 concentration had the best diagnostic utility. Our results support the hypothesis that Lp-PLA 2 may be a potential risk marker for CAD in Asian Indians., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Antiretroviral tritherapy has contributed to a considerable reduction in HIV-related mortality. The causes of death are dominated by opportunistic infections in developing countries and by cardiovascular diseases and cancer in developed countries. To determine the causes and risk factors associated with death in HIV-infected patients in two Tunisian medical centers. cross-sectional study of HIV-infected patients over 15 years treated at Sousse and Monastir medical centers between 2000 and 2014. Death was considered related to HIV if its primary cause was AIDS-defining illness or if it was due to an opportunistic infection of unknown etiology with CD4 < 50 cells/mm 3 ; it was considered unrelated to HIV if its primary cause wasn't an AIDS defining illness or if it was due to an unknown cause if no information was available. Two hundred thirteen patients, 130 men (61%) and 83 women (39%), average age 40 ± 11 years were enrolled in the study. Fifty four patients died, the mortality rate was 5.4/100 patients/year. Annual mortality rate decreased from 5.8% in 2000-2003 to 2.3% in 2012-2014. Survival was 72% at 5 years and 67% at 10 years. Death events were associated with HIV in 70.4% of cases. The leading causes of death were pneumocystis carinii pneumonia and cryptococcal meningitis in 6 cases (11%) each. Mortality risk factors were a personal history of opportunistic infections, duration of antiretroviral therapy < 12 months and smoking. Strengthening screening, early initiation of antiretroviral therapy and fight against tobacco are needed to reduce mortality in patients infected with HIV in Tunisia., Competing Interests: Les auteurs ne déclarent aucun conflit d'intérêt.

This study presents the synthesis of zirconia/multi-walled carbon nanotube (ZrO2/MWCNTs) hybrid as a novel sorbent for water defluoridation. The synthesis was facilitated by the high degree of functionalization of MWCNTs using a microwave assisted process. In the final product, nearly 3% of the carbon atoms were attached to ZrO2. The ZrO2/MWCNTs were effective in fluoride removal and mechanistic aspects of the process are presented. The research findings highlight the potential application for the use of MWCNT hybrids in environmental remediation.