There is a growing demand for colonoscopy, worldwide, resulting in increased rate of inappropriate referrals. This “overuse” of colonoscopies has become a major burden for health care. to assess the appropriateness of colonoscopies performed at the endoscopy unit of the university hospital of Sousse and to compare these results of appropriateness according to the European Panel of Appropriateness of Gastrointestinal Endoscopy (EPAGE) I and EPAGE II criteria. this cross-sectional study included all consecutive patients referred for a diagnostic colonoscopy, between January 2017 and December 2018. Patients referred for exclusively therapeutic indications, those with incomplete colonoscopies were not included. Patients with poor bowel preparation or missing data were also excluded. Indications were assessed using the EPAGE I and EPAGE II criteria. From 1972 consecutive patients, 1307 were included. Overall, 986 (75.4%) of all referrals were for out-patients. The majority of patients were referred by gastroenterologists (n = 1026 patients; 78.5%), followed by general surgeons (n = 85; 6.5%). The commonest indications were lower abdominal symptoms (275; 21%) followed by uncomplicated diarrhea (152; 11.6%). Relevant findings were present in 363 patients (27.7%). Neoplastic lesions were the dominant finding in 221 patients (16.9%). EPAGE I and EPAGE II criteria were applicable for 1237 (88.8%) and 1276 (97.7%) patients respectively. Hematochezia and abdominal pain recorded the highest inappropriate rates with both sets of criteria. Appropriate colonoscopies increased to 76.4% when EPAGE II criteria were applied; whereas uncertain and inappropriate procedures decreased to 10.3% and 10.9% respectively Appropriateness of indication was significantly higher in hospitalized patients. For the EPAGE II criteria, the specialty of the referring physician was also significantly associated to the appropriate use. The agreement between EPAGE I and EPAGE II criteria was slight using the weighted version of k (k = 0.153). The updated and improved EPAGE II guidelines are a simple and valid tool for assessing the appropriateness of colonoscopies. They decreased the inappropriate rate and the possibility of missing potentially severe diagnoses.

Healthcare-associated urinary tract infections (HAUTIs) represent a significant challenge to healthcare systems worldwide, contributing to patient morbidity, mortality, and increased healthcare costs. Understanding the epidemiology and risk factors associated with HAUTIs is crucial for implementing targeted prevention strategies and optimizing patient care. This study aimed to assess the incidence and characteristics of HAUTIs, as well as their associated factors, at the University Hospital Center Sahloul in Sousse, Tunisia. We conducted a longitudinal study over a three-month period at the University Hospital Center Sahloul in Sousse, Tunisia, over a 3-month period (September-November 2022). Patient data were collected daily, and HAUTIs were defined according to standardized criteria. Statistical analysis was performed to identify risk factors associated with HAUTIs. A total of 1947 patients were included, with an age median of 55 years and a male predominance. Patients were mainly hospitalized in medical and surgical departments with a median length of stay of seven days. Among our patients, 23.1% had been hospitalized in the past 6 months and 33% had a urinary catheter at the time of HAUTI diagnosis. The incidence of HAUTIs was 2.8% and 3.75% among catheterized patients, with an incidence density of 3.08 cases per 1000 hospitalization days. HAUTIs were more frequent in medical (3.9%) and surgical (1.9%) departments. The majority of HAUTIs were symptomatic, with fever being the most common sign. Urinary cultures were positive in all cases with the majority of pathogens isolated being Gram-negative bacteria (56.6%). Pathogens were resistant to antibiotics in 37.5% of the cases. Univariate analysis showed several risk factors associated with HAUTIs, while multivariate analysis showed independent risk factors including increased length of stay (p < 0.001), advanced age (p = 0.012), hospitalization method (p = 0.005), and history of neurogenic bladder (p = 0.019). Clinical improvement was observed in 72.2% of cases, and mortality was low (1.7%). HAUTIs remain a big concern, particularly in medical and surgical departments. Our study shows that prolonged hospitalization, advanced age, hospitalization method and history of neurogenic bladder are significant risk factors for HAUTIs. The high prevalence of antibiotic resistance highlights the need for antimicrobial stewardship programs in local hospitals. In order to reduce HAUTI incidence and improve quality of care, strict infection control measures must implemented, patients at risk must be detected early and catheter management must be optimized.

Introduction: Medical simulation has become an essential teaching method for all health professionals. It not only allows to acquire technical and non-technical knowledge, but also help the maintenance of acquired knowledge in the medium and long term. Ascites puncture is part of the basic technical procedures learned by medical students during their internship. Objectives To evaluate the role of simulation-based learning of ascites puncture on the improvement of theoretical knowledge and maintenance of skills at 3 months. Methods We conducted a quasi-experimental study at the simulation center at the Faculty of Medicine of Sousse between November 2020 and June 2021. We included learners in their third year of medical studies who had a hospital internship in the gastroenterology department at Sahloul Hospital in Sousse. All learners attended the initial simulation session on ascites fluid puncture. Thereafter, they were free to accept or refuse participation in the evaluation session that was scheduled after 3 months, depending on their availability. Results Forty learners participated in the procedural simulation of the ascites fluid puncture technique. Thirty-four (85%) were female and six (5%) were male. In our study, we showed that following procedural simulation training of ascites puncture, there was a significant improvement in the theoretical knowledge of the learners (p < 0.000). Objective assessment of technical skills after 3 months showed the benefit on performance maintenance (p < 0.000). Conclusion Our study confirmed the benefit of simulation-based learning on the improvement of theoretical knowledge and the maintenance of technical performance in the medium term.

Objectives: The main objective is to study gynecological and obstetrical emergencies among adolescents admitted to the emergency room in our department. Methods: At the Farhat Hached University Hospital in Sousse’s Obstetrics and Gynecology Department, we carried out a retrospective study. Sociodemographic and clinical characteristics of adolescents who consulted over a period of 12 months were described. Results: We recorded 78 emergencies during the study period, representing a frequency of 0.39 %. Gynecological and obstetrical emergencies in adolescents are dominated by abdominal-pelvic pain (36 %), followed by pregnancy diagnoses (16.7 %), and dysmenorrhea in 10 % of cases. Admission decisions were made in only 6.4 % of cases. Conclusions: Advances in adolescent gynecology highlight the importance of specialized care for this population, crucial for preventive healthcare. Evaluation and management rely on recognizing clinical challenges and understanding specific issues.

Introduction: Medical simulation has become an essential teaching method for all health professionals. It not only allows to acquire technical and non-technical knowledge, but also helps the maintenance of acquired knowledge in the medium and long term. Ascites puncture is part of the basic technical procedures learned by medical students during their internship. Objectives: To evaluate the role of simulation-based learning of ascites puncture on the improvement of theoretical knowledge and maintenance of skills at 3 months. Methods: We conducted an audit type study with two cycles of data collection at the simulation center at the Faculty of Medicine of Sousse between November 2020 and June 2021. We included learners in their third year of medical studies who had a hospital internship in the gastroenterology department at Sahloul Hospital in Sousse. All learners attended the initial simulation session on ascites fluid puncture. Thereafter, they were free to accept or refuse participation in the evaluation session that was scheduled after 3 months, depending on their availability. Results: Forty learners participated in the procedural simulation of the ascites fluid puncture technique. Thirty-four (85%) were female and six (5%) were male. In our study, we showed that following procedural simulation training of ascites puncture, there was a significant improvement in the theoretical knowledge of the learners (p < 0.000). Objective assessment of technical skills after 3 months showed the benefit of performance maintenance (p < 0.000). Conclusion: Our study confirmed the benefit of simulation-based learning on the improvement of theoretical knowledge and the maintenance of technical performance in the medium term.