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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

Accidental blood exposure (ABE) is major problem of occupational safety among health care workers. This work aimed to assess the gender differences among health care workers of a public hospital in the central region of Tunisia.MethodsAn exhaustive retrospective study was conducted over a period of fourteen years, concerning ABE reported in the Department of Occupational Medicine of a public hospital in the central region of Tunisia (Mahdia). The data collected were related to socio-professional characteristics of victims, circumstances of the accident and immediate and follow-up care. Gender groups were compared.ResultsA total of 650 ABE were reported during the study period. Victims were predominately female (sex ratio=0.47), mean aged 32.1±9.4 years and having a mean job tenure of 5.5±7.7 years. Paramedics represented 28.3%. AEB were caused by a needle stick in 82.6% of cases. Needle recapping was the direct cause in 10.6% of cases. Only 47.1% of caregivers were wearing gloves at the time of ABE. Women were more exposed to ABE with a higher risk of contamination, but with no statistically significant difference (p=0.33). Immediate care was in accordance with universal recommendations in 34.1% of cases and less adequate among women (p=0.05). The initial serology was prescribed in 82.6% of cases, that of the 3rd month in 5% of cases and that of the 6th month in 1.2% of cases. Women were less adherent to follow-up with a statistically significant difference at six months (p=0.016). Hepatitis B vaccination schedule was correctly followed in 79% of cases. Women were more adherent than men (p=0.029). Logistic regression analysis did not reveal gender as a predictor of vaccination status (p=0.211).ConclusionThe current study has revealed a high prevalence of ABE mainly among female health care workers with unsatisfactory management, including inadequate immediate care and incomplete post-accident follow-up.

Background In COVID-19 management, a variety of pharmaceutical interventions (PI) and non- pharmaceutical interventions (NPI) were adopted to limit the spread of the disease and its associated deaths. We aimed to evaluate the impact of PI and NPI on risks of COVID-19 transmission and deaths. Method We collected aggregate data from March 2nd, 2020, to December 1, 2022 from the Tunisian Ministry of Health's website and OurWorldInData.org site. NPI Periods (NPIP: March 2020 to March 2021) and PI Periods (PIP) were distributed to NPIP1, 2, 3 and 4 and to PIP1, 2, 3 and 4, respectively. We calculated the Relative Risks (RR) and 95% Confidence Intervals (CI) by comparing the subsequent period with previous one. Results The risk of SARS-CoV-2 transmission increased progressively from the zero cases period (NPIP2) to the mitigate strategy period (NPIP3) (RR = 14.0; 95% CI: 12.4–15.8) and to the stop-and-go epidemic control period (NPIP4) (RR = 23.1 (95% CI: 22.4–23.9). It was stabilized in the targeted vaccination period (PIP1) (RR = 1.08, 95% CI: 1.07–1.08) and reduced during the mass vaccination period (PIP2) (RR: 0.50, 95% CI: 0.50–0.51). SARS-CoV-2 transmission, increased during PIP3 concomitant with the Omicron wave (RR = 2.65, 95% CI: 2.64–2.67). It remained at a low level in PIP4 (RR = 0.18; 95% CI: 0.18–0.18). Compared to NPIP2, NPIP3 and NPIP4 were associated with a higher risk of COVID-19 mortality (RR = 3.337; 95% CI: 1.797–6.195) and (RR = 72.63 (95% CI: 54.01–97.68), respectively. Since the start of the immunization program, the risk of COVID-19 death has consistently decreased. In comparison to each previous period, the risk transitioned in PIP1 to RR = 0.91; 95% CI: 0.88–0.93, then to RR = 0.85; 95% CI: 0.83–0.88 in PIP2, to RR = 0.47; 95% CI: 0.45–0.50 in PIP3, and to RR = 0.19; 95% CI: 0.18–0.24 during PIP4. Conclusion In terms of lowering the risk of transmission and mortality, the NP strategy at the beginning of the epidemic outperformed the IP strategy during the outbreak.

Acetamiprid is one of the most widely used neonicotinoids. This study investigates toxic effects of repeated oral administration of three doses of acetamiprid (1/20, 1/10, and 1/5 of LD 50 ) during 60 days. For this, male Wistar rats were divided into four different groups. Hematological, biochemical, and toxicopathic effects of acetamiprid were evaluated. According to the results, a significant decrease in the body weight gain at the highest dose 1/5 of LD 50 of acetamiprid was noticed. An increase in the relative liver weight was also observed at this dose level. The hematological constituents were affected. A significant decrease in RBC, HGB, and HCT in rats treated with higher doses of acetamiprid (1/10 and 1/5 of LD 50 ) was noted. However, a significant increase in WBC and PLT were observed at the same doses. Furthermore, acetamiprid induced liver toxicity measured by the increased activities of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphates (ALPs), and lactate dehydrogenase (LDH) which may be due to the loss of hepatic membrane architecture and hepatocellular damage. In addition, exposure to acetamiprid resulted in a significant decrease in the levels of superoxide dismutase and catalase activities ( p  ≤ 0.01) with concomitant increase in lipid peroxidation in rat liver. These findings highlight the subchronic hepatotoxicity of acetamiprid.

Disorders of sexual development (DSD) are a heterogeneous group of genital defects affecting chromosomal, gonadal and anatomical sex. 46,XY DSD is a subset of DSD which covers a wide range of phenotypes in which 46,XY gonadal dysgenesis (GD) is the most severe form. In this study, we report on the clinical and molecular cytogenetic findings of a study on a Tunisian girl with the syndromic form of 46,XY DSD. This case was a phenotypic female patient having several congenital anomalies including growth retardation. Karyotype, fluorescence in situ hybridization and array Comparative Genome Hybridization (array CGH) were performed. The proband exhibited a de-novo 46,X,der(Y) karyotype. Array CGH revealed a pathogenic 27.5Mb gain of an Xp21.2 chromosome segment leading to Xp functional disomy. No deletion was observed in the Y-chromosome. The duplicated region encompassed the NR0B1 (DAX1) and MAGEB genes, located within the dosage sensitive sex (DSS) reversal locus, known as promote genes responsible for human sex reversal and testis repression. The extra-dosage and interactions of these genes with different specific genes could result in the impairment of the male sex pathway. Over-dosage of KAL1 and IL1RAPL1 genes fall within the somatic features observed in the patient. To the best of our knowledge, we report on the fourth case of Xp21.2-pter duplication within Xp;Yp translocation associated with XY GD. Our findings suggest that when duplicated, the NR0B1 and MAGEB genes could be a major cause of XY GD. Therefore, we emphasize the usefulness of a combined cytogenetic approach in order to provide an accurate genetic diagnosis for those patients having syndromic XY DSD in a clinical setting.

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.

Durum wheat landraces have huge potential for the identification of genetic factors valuable for improving resistance to biotic stresses. Tunisia is known as a hot spot for Septoria tritici blotch disease (STB), caused by the fungus Zymoseptoria tritici (Z. tritici). In this context, a collection of 3166 Mediterranean durum wheat landraces were evaluated at the seedling and adult stages for STB resistance in the 2016–2017 cropping season under field conditions in Kodia (Tunisia). Unadapted/susceptible accessions were eliminated to reach the final set of 1059 accessions; this was termed the Med-collection, which comprised accessions from 13 countries and was also screened in the 2018–2019 cropping season. The Med-collection showed high frequency of resistance reactions, among which over 50% showed an immune reaction (HR) at both seedling and adult growth stages. Interestingly, 92% of HR and R accessions maintained their resistance levels across the two years, confirming the highly significant correlation found between seedling- and adult-stage reactions. Plant Height was found to have a negative significant effect on adult-stage resistance, suggesting that either this trait can influence disease severity, or that it can be due to environmental/epidemiological factors. Accessions from Italy showed the highest variability, while those from Portugal, Spain and Tunisia showed the highest levels of resistance at both growth stages, suggesting that the latter accessions may harbor novel QTLs effective for STB resistance.

Introduction Textiloma refers to a retained surgical textile material within the body after surgery. It is a rare but serious iatrogenic complication that may remain asymptomatic for years. Case Presentation We report a case of a 38-year-old woman with a history of open ovarian cystectomy 15 years earlier, presenting with persistent abdominal pain. Imaging revealed a complex pelvic mass with abscess formation and enteric fistula. Despite interventional drainage and antibiotic therapy, the patient developed signs of sepsis. Endoscopic evaluation revealed a retained surgical textile in the rectum, which was extracted. The patient subsequently developed generalized peritonitis and underwent emergency laparotomy revealing two retained textilomas and multiple intestinal perforations. Despite aggressive surgical intervention, the patient succumbed to septic shock on postoperative day one. Conclusion Textiloma should be considered in patients with atypical abdominal masses and previous surgical history. Preventive strategies and early recognition are critical to avoid fatal outcomes.

We aimed to study the relationship between age and time to negative conversion of SARS-CoV-2 in patients with asymptomatic and mild forms of COVID-19. We conducted a cohort study including all patients diagnosed with COVID-19 from the national COVID-19 containment center of Tunisia. Patients were subdivided into two cohorts: (under 60 years) and (over 60 years) and were followed up until PCR negativization. Log rank test and Cox regression were applied to compare time to negative conversion between the old group and the young group. The study included 289 patients with non-severe forms of COVID-19. Age over 60 was significantly associated with delayed negative conversion in male sex (Hazard ratio (HR): 1.9; 95% CI: 1.2-3.07) and among patients with morbid conditions (HR:1.68; 95% CI: 1.02-2.75) especially diabetics (HR: 2.06; 95% CI: 1.01-4.21). This association increased to (HR:2.3; 95% CI: 1.13-4.66) when male sex and comorbidities were concomitantly present and rose to (HR: 2.63; 95% CI: 1.02-6.80) for men with diabetes. Cox regression analysis revealed a significantly delayed negative conversion in symptomatic patients. Significant interaction was observed between gender and age and between age and chronic conditions. Age is associated with delayed negative conversion of viral RNA in certain subgroups. Identifying these subgroups is crucial to know how prioritize preventive strategies in elderly.

This study aims to investigate the effects of chlorpyrifos’s sub-acute exposure on male rats. Two groups with six animals each were orally treated, respectively, with 3.1 mg/kg b w and 6.2 mg/kg b w of chlorpyrifos during 4 weeks. The genotoxic effect of chlopyrifos was investigated using the comet assay and the micronucleus test. Some hematological and liver’s histopathological changes were also evaluated. Results revealed that chlorpyrifos induced histopathological alterations in liver parenchyma. The lymphoid infiltration observed in liver sections and the increase in white blood cells parameter are signs of inflammation. A significant increase in the platelet’ count and in polychromatic erythrocytes/normochromatic erythrocytes (PCE/NCE) ratio was observed in chlorpyrifos-treated groups which could be due to the stimulatory effect of chlorpyrifos on cell formation in the bone marrow at lower doses. In addition, the increase of bone marrow micronucleus percentage and the comet tail length revealed a genotoxic potential of chlorpyrifos in vivo.