Describe the epidemiology of tuberculosis in the last two decades (2000–2019) in the East region of Tunisia (city of Sousse). This was a descriptive retrospective analysis of notified incident cases of tuberculosis from 2000 to 2019 in Sousse Governorate, Tunisia. The data collection was done via the regional registry of tuberculosis. Stata software was used to characterize the socio-demographic and clinical profile of tuberculosis, to calculate its incidence, mortality and fatality rates and to determine predictive factors of mortality. R software was used to analyze the chronological trend of tuberculosis incidence and mortality. A total of 2606 incident cases of tuberculosis were declared from 2000 to 2019 in Sousse. The mean age was 39 ± 19 years with a sex ratio (male/female) of 1.19. Only one case was HIV positive among the total 2606 incident cases. Extra-pulmonary tuberculosis was the most recorded (1,534 cases, 58.9%). The mean annual case notification and deaths were 130 and four respectively. After adjusting for confounders, individuals with pulmonary tuberculosis were 1.9 significantly more likely to die from tuberculosis compared to those suffering from extra-pulmonary tuberculosis. There was a trend of increasing mortality with increasing age. The association was statistically significant only for those above 60 years’ old who had 12.5 times higher odds of dying compared to those below 60 years. After adjusting for age and gender, with every year there was an increase in the total incidence rate (+0.35 per 100,000) with p = 0.005 and in the extra-pulmonary incidence (+0.27 per 100,000), with p = 0.001. This study demonstrated the increasing trend of tuberculosis in Sousse, Tunisia from 2000 to 2019. The national program against tuberculosis should enhance community knowledge and centralize the national and regional epidemiological information for better epidemiological surveillance.

The objective of this work was to establish the bibliometric profile of Tunisian theses in ‘general surgery’ and to describe their themes, their study designs, and their writing quality. This is a retrospective descriptive bibliometric study, covering all the theses in medicine in the specialty of ‘general surgery’, defended in the four medical faculties of Tunisia, during the forty last years from 1980 to 2019. During the study period, 739 theses in ‘general surgery’ were discussed in Tunisia, with an average of 19 theses per year. The most studied research topic was emergencies (41%), followed by common surgical pathologies (26%) and digestive oncology (21.5%). Descriptive studies and case studies represented the majority of study designs with respective proportions of 56.9% and 40.6%. Only 20.7% of these theses had a scientific writing quality deemed satisfactory. The least respected elements in writing their summaries were statistical (confidence intervals and standard deviations) and documentary (keywords). Despite the plethora of themes of Tunisian theses in ‘general surgery’, their basic methodology and their editorial non conformity require the educational reform of the dissertations, both doctoral students and supervisors, by strengthening their skills in research methodology and scientific communication written.

Context: Primary Health Care is the first level of healthcare delivery services. Its role in the management of epidemics has been documented especially during the SARS and Ebola epidemics, and more recently during the COVID-19 pandemic. Objective: To describe public health experts’ perceptions of the implication of Primary Health Care on managing the COVID-19 pandemic in Tunisia. Methods: This qualitative study was based on a structured interview covering five domains: 1. Preparedness, 2. Implication, 3. Health delivery, 4. Response and 5. Fight against COVID-19 in Primary Health Care in Tunisia. Convenient sampling was done to include public health practitioners and experts. Results: A total of 25 experts were included with a sex ratio that was equal to 0.92, including two international experts, and four that were working in the Ministry of Health. The majority of respondents affirmed that the Tunisian PHC was not prepared to fight against the COVID-19 pandemic. Concerning the response role of PHC against COVID-19, some experts stated that PHC played an important role in the early stages of the pandemic. Almost all included participants claimed that PHC was marginalized from the national strategy against COVID-19. In addition, all respondents affirmed that there had been a weakening effect of the delivery of the minimum healthcare package that was dispended by the PHC after the pandemic. However, they all expressed the ability of PHC to manage future epidemics. Conclusion: The Tunisian PHC system did not play an efficient role in the current COVID-19 pandemic. However future lessons should be deduced for further implications in potential upcoming epidemics.

Introduction: l'artérite de Takayasu (AT), une vascularite systémique chronique, reste un défi clinique, particulièrement dans les pays à faible revenu, en raison des difficultés de diagnostic précoce, d'évaluation lésionnelle et de prise en charge optimale. L'objectif était de décrire les difficultés diagnostiques, exploratoires et thérapeutiques de l'AT dans les services de référence, de la région de Sousse (Tunisie). Méthodes: il s'agissait d'une étude descriptive, rétrospective et exhaustive, réalisée dans les deux services de médecine interne de Sousse (Sahloul et Hached), colligeant les patients suivis pour AT, durant la période de 1996-2020. La maladie a été définie conformément aux critères de classification de l'American Collège of Rheumatology. L'activité de la maladie a été évaluée selon les critères du National Institute of Health. L'âge se référait à la date diagnostique. Résultats: l'étude a inclus 40 patients (Sahloul: n = 32, Hached: n = 8), avec une prédominance féminine 85% (n = 34) et un âge médian = 35 ans (IIQ = [30-41]). Le délai diagnostic médian a été de 5 mois (IIQ= [2-14]). Le signe clinique prédominant était l'abolition/diminution des pouls (78%, n = 31), tandis que la lésion artérielle la plus fréquente était la sténose du tronc supra-aortique (98%, n = 39). Le traitement reposait sur les corticostéroïdes dans 95% des cas (n = 38) et les immunosuppresseurs dans 42% (n = 17). La revascularisation et la biothérapie n'ont été appliquées successivement que chez 32% (n = 13) et 10% (n = 4) des patients. Le profil évolutif de l'AT a été active dans 62% des cas (n = 25), avec des complications vasculaires chez 60% des patients (n = 24) et des complications iatrogéniques dans 35% des cas (n = 14). Conclusion: la prise en charge de l'AT dans la région de Sousse (Tunisie) reste encore confrontée à un polymorphisme clinique, retardant son diagnostic et exposant aux évènements indésirables. Ces résultats mettent en évidence les défis persistants dans le suivi de cette maladie dans notre contexte, soulignant la nécessité d'améliorer les protocoles diagnostiques locaux.