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Carbon-encapsulated iron nanoparticles (Fe@C) with a mean diameter of 15 nm have been synthesized using evaporation–condensation flow–levitation method by the direct iron-carbon gas-phase reaction at high temperatures. Further, Fe@C were stabilized with bovine serum albumin (BSA) coating, and their electromagnetic properties were evaluated to test their performance in magnetic hyperthermia therapy (MHT) through a specific absorption rate (SAR). Heat generation was observed at different Fe@C concentrations (1, 2.5, and 5 mg/mL) when applied 331 kHz and 60 kA/m of an alternating magnetic field, resulting in SAR values of 437.64, 129.36, and 50.4 W/g for each concentration, respectively. Having such high SAR values at low concentrations, obtained material is ideal for use in MHT.

A novel core-shell nanomaterial, ZnO nanoparticles (NPs), and a shell-core ZnO@SiO 2 using extracts from Calligonum comosum L. leaves successfully fabricated. The investigation focuses on evaluating the photocatalytic efficiency of the produced catalyst against organic pollutants. SiO 2 NPs, ZnO NPs, and shell-core ZnO@SiO 2 structures exhibit spherical morphologies with average diameters of approximately 25–50 nm, 50–100 nm, and 35–65 nm, respectively. SiO 2 NPs possess an amorphous structure, while ZnO NPs, SiO 2 NPs, and the ZnO shell exhibit crystalline arrangements, featuring average crystallite sizes of 32.8 nm, 62.3, and 13.5 nm, respectively. Band gap energies are determined to be 3.6 eV, 2.3 eV, and 2.15 eV for SiO 2 NPs, ZnO NPs, and ZnO@SiO 2 nanocomposite, respectively. Catalytic performance is evaluated using Methylene Blue (MB) as a cationic dye and Rose Bengal (RB) as an anionic dye. Remarkably, the shell-core ZnO@SiO 2 nanocomposite achieves degradation efficiencies of 99.3% for MB and 98.0% for RB, surpassing ZnO NPs with degradation coefficients of 86.6% for MB and 91.7% for RB. These degradation processes occur under solar light irradiation, at a contact time of 120 min, pH 7, and temperature of 25 °C. The study underscores the potential of the ZnO@SiO 2 nanocomposite as an effective, cost-efficient, and environmentally friendly solution for water treatment. Graphical abstract

Background Cervical radiculopathy (CR) is a common condition, often associated with cervicogenic headache (CGH), a secondary headache arising from cervical spine disorders. Mechanical intermittent cervical traction (MICT) is frequently prescribed to treat CR symptoms. The purpose of the study was to make a preliminary estimate of efficacy of adding MICT to conventional rehabilitation on CGH in patients with cervical radiculopathy. Methods A total of 36 CR patients with CGH were randomly allocated to 3 equally sized groups (A, B and C). The treatment consisted of twelve sessions of conventional rehabilitation (4 weeks) combined with MICT (2 kg for group A, 8 kg for group B and 12 kg for group C). Primary outcomes were CGH intensity (visual analog scale) and frequency (days per week). Secondary outcomes were radicular pain intensity (visual analog scale), cervical range of motion (cervical range of motion instrument), proprioception (cervical range of motion instrument) and muscle strength (MicroFET2 dynamometer), handgrip strength (handheld dynamometer), function (Neck Disability Index), kinesiophobia (Tampa Scale for KInesiophobia), anxiety and depression (Hospital Anxiety and Depresion questionnaire), and quality of life (World Health Organization Quality of Life). Patients were assessed at baseline, one, three and six months after the beginning of treatment. The post hoc Dunn testing was used to determine which traction load had the better effect on CGH symptoms. Results At one, three and six months follow-ups, Group C exhibited the highest improvement in CGH intensity and frequency compared to the other groups ( p  = 0.021 and p  = 0.023; p  = 0.012 and p  = 0.01; p  = 0.005 and p  = 0.005). Both groups C and B showed a significant improvement in radicular pain compared to group A at one month follow-up ( p  = 0.05).The improvement in group C was significantly better in terms of function ( p  = 0.049) and anxiety ( p  = 0.011) at three months and quality of life at six months (Psychological p  = 0.046 and Environment p  = 0.006). Conclusions The blend of conventional rehabilitation alongside 12 kg MICT seems to be efficacious in diminishing both the intensity and frequency of CGH in patients with CR. These advantages appear to last for up to six months following the treatment period, potentially leading to decreased CGH severity and occurrence rates, heightened functionality, reduced anxiety levels, and an overall enhancement in quality of life. These findings are preliminary and require confirmation in larger trials. Trial registration The study protocol was retrospectively registered at the Pan African Clinical Trial Registry (PACTR202401838955948). Date of registration is 16/01/2024.

To examine critical Covid-19-acute respiratory distress syndrome (C-ARDS) patients requiring mechanical ventilation (MV), using transthoracic echocardiography (TTE) coupled with bubble test (BT), in order to search a right/left shunt. A Cross-sectional and comparative study comparing several parameters according to the presence or not of shunt. 75 patients were included. Twenty-three shunts (31%) were detected: patent foramen oval (PFO) type [n=11 (15%)] and trans-pulmonary transit of bubbles (TPBT) [n = 12 (16%)]. The shunt did not affect P/F ratio (P/F=77 vs 81, p=0.97), nor mortality. A right/left shunt was detected in a third of studied patients similarly between PFO and TPBT without significant impact on P/F ratio or outcome.

Background The aim of this study was to characterize the transmission chains and clusters of COVID-19 infection in Tunisia. Methods All cases were confirmed by Reverse Transcriptase Polymerase Chain Reaction of a nasopharyngeal specimen. Contact tracing is undertaken for all confirmed cases in order to identify close contacts that will be systematically screened and quarantined. Transmission chains were identified based on field investigation, contact tracing, results of screening tests and by assessing all probable mode of transmission and interactions. Results As of May 18, 2020, 656 cases out of a total of 1043 confirmed cases of Coronavirus disease 2019 belong to 127 transmission chains identified during the epidemic (mean age 42.36 years, Standard deviation 19.56 and sex ratio 0.86). The virus transmission is the most concentrated in the governorate of Tunis (31.5%), Ariana (10.2%) and Ben Arous (10.2%). Virus transmission occurred 50 times (9.72% of secondary transmission events) between two different governorates. A maximum of seven generations of secondary infection was identified, whereas 62% of these secondary infections belong the first generation. A total of 11 “super spreader” cases were identified in this investigation. Four large clusters have been identified. The evolution of secondary cases highlighted two peaks: one in 2nd April and a second in 16 th April whereas imported cases caused local transmission of virus during the early phase of the epidemic. Conclusion Correct contact tracing and early active case finding is useful to identify transmission chains and source of infection in order to contain the widespread transmission in the community.

Introduction Acute appendicitis (AA) is the most common surgical emergency in pediatric patients, yet its diagnosis remains challenging due to variable clinical presentations and the overlap with other causes of abdominal pain. Predictive scores can enhance diagnostic accuracy, reduce unnecessary surgeries, and optimize resource utilization, especially in resource-limited settings. This study aimed to identify key predictive factors for acute appendicitis in children and to develop a combined clinical and biological scoring system to enhance diagnostic accuracy for this condition. Patients and methods We prospectively enrolled children aged 2 to 14 years presenting with abdominal pain to the pediatric surgery department at Fattouma Bourguiba University Hospital over a one-year period. Clinical, biological, and sonographic data were analyzed to identify key predictive factors and derive a predictive scoring model for acute appendicitis in this population. Model performance was assessed using the area under the curve (AUC) on the same dataset used for model derivation. Results Among 420 children presenting with abdominal pain, 91 (21.7%) were diagnosed with AA. The median age of the children was 7 years, with a male-to-female ratio of 1.48. Binary logistic regression identified the following predictive factors: right iliac fossa tenderness, right iliac fossa guarding, positive right single-leg hop, and neutrophil percentage ≥ 75%. The predictive model achieved an AUC of 0.901 (95% CI [0.85–0.93]) with a significance of P < 0.0001. The optimal cut-off for the model was 5, yielding a sensitivity of 61.04%, specificity of 95.38%, positive predictive value (PPV) of 76.4%, and negative predictive value (NPV) of 90.5%. Stratified management strategies based on the score were proposed to guide clinical decision-making effectively. Conclusion The developed predictive score offers a simple, practical, and highly specific tool for diagnosing AA in pediatric emergencies. Its integration of functional signs, such as the right-sided single-leg hop test, enhances clinical utility, making it particularly valuable in resource-constrained settings. Further validations are warranted to confirm its generalizability and reliability. Clinical trial number Not applicable. Level of evidence II

A novel CuO–SiO 2 nanoadsorbent, incorporating copper oxide (CuO) and silicon dioxide (SiO 2 ), has been successfully synthesized using three distinct preparation processes: Mode-A (solution and solution), Mode-B (solution and nanoparticles), and Mode-C (nanoparticles and nanoparticles). The investigation focuses on evaluating the efficiency of the CuO–SiO 2 nanoadsorbent, considering its synthesis process, reusability, and sustained performance over time, particularly in the removal of Rose Bengal dye. Characterization results revealed the formation of CuO–SiO 2 nanocomposites structure irregular shapes morphology across all three-preparation processes. The average particle sizes for Mode-A, Mode-B, and Mode-C nanocomposites were determined as 18.1 nm, 15.6 nm, and 14.8 nm, respectively. Furthermore, the band gap energies of the CuO–SiO 2 nanocomposites were measured at 2.2 eV, 1.8 eV, and 3.29 eV for Mode-A, Mode-B, and Mode-C, respectively. Remarkably, the CuO–SiO 2 nanocomposite prepared using Mode-B demonstrated superior photocatalytic activity in degrading the anionic dye Rose Bengal, achieving a degradation coefficient of 84.8%. In comparison, CuO NPs, tested under the same experimental conditions (120 min contact time, pH = 7, temperature of 25 °C, and solar light irradiation), achieved a degradation coefficient of 78.8%. These findings highlight the potential of the CuO–SiO 2 nanoadsorbent, particularly when synthesized via Mode-B, for effective and environmentally friendly dye degradation applications.

Aims Breathlessness is the primary symptom of decompensated heart failure (HF), but the prevalence and evolution of persistent respiratory distress post‐hospitalization remain unclear. Methods and results The Longitudinal Observational Study for mIddle Term Follow‐up Patients Admitted for Acute Dyspnea in TunIsia (SIDI) study is a prospective and multicentre study on HF patients with preserved ejection fraction admitted for acute dyspnoea. Patients were followed for 6 months. The primary endpoint was to assess the incidence of persistent respiratory distress and factors linked to respiratory recovery at Day 90. The secondary endpoint was rehospitalization and/or death at Day 90 and 180. Among 231 patients, 140 had SpO2 and respiratory rate data at Day 90. Persistent respiratory distress was observed in 97 (69%). Multivariable analysis found no association between respiratory recovery and sex, diabetes, hypertension, kidney disease or NT‐proBNP levels. However, intensive follow‐up (n = 54) with oral neuroendocrine inhibition significantly improved respiratory parameters at Day 90 (adjusted HR: 5.70 [95% CI 2.13–18.28], P = 0.0001) compared with standard follow‐up (n = 86) and reduced rehospitalization and/or death at Day 90 and 180. Conclusions Persistent respiratory distress is frequent in the months following HF hospitalization. Optimized guideline‐directed therapy and close follow‐up improve respiratory recovery. SpO2 and respiratory rate monitoring should be integrated into HF management. The Longitudinal Observational Study for mIddle Term Follow‐up Patients Admitted for Acute Dyspnea in TunIsia (SIDI) study is a prospective and multicentre study on HF patients with preserved ejection fraction admitted for acute dyspnoea. The primary endpoint was to assess the incidence of persistent respiratory distress and factors linked to respiratory recovery at Day 90.

Background: Few randomized controlled trials have examined the efficacy time of smoking cessation in hospitalized patients with acute coronary syndrome, either during hospitalization or after discharge. Aims: To assess smoking cessation rates at 24 weeks among patients with acute coronary syndrome. Group A had begun nicotine replacement therapy during hospitalization, and Group B after discharge. We also determined factors predicting success. Methods: We conducted a randomized controlled trial in the Cardiology Department and Smoking Cessation Service at University Hospital of Monastir, Tunisia from January 2015 to June 2016. Participants were randomly assigned to the above 2 groups. The endpoint assessment was smoking abstinence at 24 weeks, defined as self-reported abstinence in the past week, confirmed by measured exhaled carbon monoxide (CO) [less than or equal to] 8 ppm. We analysed data by intention to treat. We used a binary logistic regression model to determine factors predicting abstinence. Results: All participants were male and mean (standard deviation) age was 55 (11) years. At 24 weeks there was no significant difference in smoking cessation rate between the 2 groups: 54.5% [95% confidence interval (CI): 44.7-64.3%] in Group A and 45.5% (95% CI: 35.7-55.3%) in Group B (P = 0.81). High level of nicotine dependence [odds ratio (OR): 0.72; 95% CI: 0.54-0.96) and good compliance during follow-up (OR: 6.56; 95% CI: 2.07-20.78) were predictive factors for abstinence. Conclusions: Smoking cessation rate after acute coronary syndrome was high regardless of the start date. Good compliance during follow-up was the key predictive factor for success.

Background The global impact of the COVID-19 pandemic was remarkably diverse, unfolding with multiple waves that have touched countries and continents in distinctive ways, leading to varying rates of mortality. The objectives of this study were to examine the characteristics and in-hospital fatality rates of COVID-19 patients hospitalized in the Monastir governorate over two years, with an overall analysis and a wave-specific breakdown throughout the pandemic's progression. Methods We carried out a two-year longitudinal study, enrolling all COVID-19-infected patients admitted to both public and private health facilities in the governorate of Monastir from March 2020 to March 2022. The study covered six complete infection waves. Patients were followed from their first day of admission to their outcome in hospital. The data were collected using a questionnaire manually completed by well-trained residents. The data were globally analyzed across all hospitalized patients and then compared based on the different waves. Results Overall, 5176 were hospitalized. The cumulative in-hospital case fatality rate (CFR) over the study period was 21.4%. After the first wave (W1), the in-hospital CFR followed a gradual increase, reaching its peak at 27.5% during W4 ( alpha variant ). Later, it decreased to 21.8% during W5 ( delta variant ), and further declined to 19.5% during W6, associated with the Omicron variant (overall p  < 0.001). W5 exhibited the highest proportions of infections, hospitalizations, and in-hospital deaths. W6 featured a low hospitalization rate of 2.8% and a decline in severe cases. Nevertheless, there was a significant surge in hospitalizations among both the pediatric (≤ 18 years) and geriatric (≥ 75 years) populations, with a pronounced impact on the elderly with chronic conditions. This surge resulted in an increase in fatalities among the elderly. The length of stay (LoS) decreased throughout the course of the pandemic, declining from 13 days [10;14] in W1 to 4 days [2;9] in W6 with almost half of them had a LoS less than seven days (55.6%). Conclusion This study underscores the critical interplay of variant-specific disease severity, patient demographics, and evolving healthcare responses in managing COVID-19's impact on hospital outcomes.