Background and Objectives: Knee arthroplasty often leads to marked postoperative muscle weakness, with strength losses of up to 62% in the first month, contributing to functional impairment and patient dissatisfaction. Blood flow restriction (BFR) training, which combines low-load exercise with partial vascular occlusion, has shown promise in enhancing muscle strength across musculoskeletal conditions and may represent a valuable rehabilitation strategy for this vulnerable population. This review aimed to systematically evaluate the effectiveness and safety of BFR training in improving muscle strength and functional outcomes following knee arthroplasty. Materials and Methods: This systematic review was prospectively registered within PROSPERO (CRD420250652404) and conducted according to PRISMA guidelines. PubMed, Embase, and Cochrane Library were searched through February 2025 for randomized controlled trials (RCTs) investigating BFR training in knee arthroplasty patients. Study selection, data extraction, and risk of bias assessment (RoB 2 tool) were performed independently by two reviewers. Eligible trials reported muscle strength and/or functional outcomes as primary or secondary endpoints. Results: Four RCTs, including 148 patients undergoing total knee arthroplasty (mean age: 67 ± 6.5 years), met the inclusion criteria. All applied preoperative BFR training for 4–8 weeks with heterogeneous protocols. Two trials demonstrated significant improvements in muscle strength (1 RM leg press, 1 RM knee extension; large effect sizes) and functional outcomes (6 min walk test, 30 s sit-to-stand; earlier recovery), favoring BFR. The remaining studies showed no significant between-group differences, though moderate-to-large effect sizes generally favored BFR training. No adverse events were reported. Conclusions: Prehabilitation with BFR training shows considerable potential to enhance early postoperative muscle strength and functional recovery in patients undergoing knee arthroplasty, particularly when compared with usual care lacking structured preoperative intervention. The evidence to date suggests that BFR is a safe and well-tolerated strategy, offering an alternative for patients who cannot perform high-load resistance training. Its favorable safety profile, combined with the potential to accelerate functional recovery, highlights the promise of BFR for reducing rehabilitation costs and healthcare utilization. Nonetheless, larger, high-quality RCTs with standardized protocols and extended follow-up are required to confirm these preliminary findings and establish clear clinical guidelines for their implementation.

Background and Objectives: Tennis involves repetitive high-velocity movements, rapid directional changes, and challenging environmental conditions, exposing players to injury risk. However, injury surveillance data for North African youth players are lacking. This study aimed to determine the frequency, characteristics, and management of tennis-related injuries among competitive Tunisian youth players. Materials and Methods: A cross-sectional study was conducted among players aged 5–18 years from tennis clubs (October 2023–November 2024). Data were collected using researcher-administered questionnaires, incorporating the Oslo Sports Trauma Research Center Overuse Injury Questionnaire and a sport-specialization assessment, following International Olympic Committee guidelines. Results: Among 256 players, 53.5% (n = 137) reported 366 injuries. Lower limbs were most affected (58.5%), followed by upper limbs (32.8%); knees (23.2%), ankles (17.5%), and wrists (10.1%). Muscle/tendon (36.9%), superficial tissue (28.1%), and ligament/joint capsule injuries (27.6%) predominated. Most injuries occurred during practice (74.9%) and hot weather (93.4%). Severe injuries represented 24%, while 29.5% were minor without time loss. Subsequent injuries occurred in 54.6% of injured players, with significantly higher rates in those with incomplete rehabilitation (p < 0.001). Conclusions: The high frequency of recurrent injuries and limited rehabilitation highlight critical gaps in injury management, emphasizing the need for targeted neuromuscular training, accessible rehabilitation, and standardized return-to-play protocols.

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.

Rationale: Osteochondroma (OC) is a benign bone tumor commonly found near the ends of long bones. While spinal and hip localizations are rare, bilateral hip involvement is often associated with hereditary multiple exostoses, occurring in 30% to 90% of such cases. This report describes a unique case of bilateral hip OC developing after a spinal cord injury, in the absence of family history or hereditary multiple exostoses. Patient concerns: A 35-year-old male presented with painful bilateral hip swelling and restricted mobility following a rural accident that caused a C6–C7 vertebral fracture with bilateral anterior dislocation of the articular facets. He also exhibited spastic tetraplegia and flexion contractures, with signs suggestive of femoral nerve compression. Diagnoses: Initial imaging revealed myositis ossificans involving the iliopsoas and spinal muscles. A bone scan identified an immature osteoma. Histopathological examination following surgical excision confirmed the diagnosis of OC. Interventions: The patient underwent spinal surgery 2 days after the trauma, followed by admission to a physical medicine rehabilitation unit. Surgical resection of the left hip lesion improved flexion, and a similar procedure on the right hip yielded temporary improvement but led to complications, including infection requiring antibiotics and drainage. Outcomes: Despite surgical interventions, tumor recurrence occurred within 3 months. Imaging confirmed recurrent myositis ossificans and fluid collections. One year postinjury, neurological deterioration was noted, with spastic tetraplegia progressing from the C5 to C7 level and worsening lower limb spasticity. Valium was introduced for spasm management. Lessons: This case highlights a rare occurrence of bilateral hip OC following spinal cord injury and raises important questions about trauma-induced mechanisms in OC pathogenesis. It suggests the need for further investigation into the relationship between spinal trauma, heterotopic ossification, and tumor development.

Background: Adolescence represents a critical period for growth and athletic development, yet young athletes frequently demonstrate significant gaps in nutritional knowledge that can impair performance and long-term health outcomes. Limited research exists on comprehensive nutrition education interventions for adolescent soccer players in North African populations. Objective: To evaluate both general and sports-specific nutritional knowledge among adolescent soccer players from an elite Tunisian club and assess the feasibility of a digital nutrition intervention using mobile application technology. Methods: A cross-sectional survey was conducted between June and August 2024 among 50 male soccer players aged 11–18 years from Étoile du Sahel club in Sousse, Tunisia. Data were collected via a structured questionnaire comprising sections on basic nutrition knowledge, influences on food choices, sports nutrition knowledge and practices, and demographic information. A pilot digital intervention using the FatSecret app was implemented with 8 participants over 4 weeks, involving meal photo uploads and nutritionist feedback. Results: Participants had a mean age of 15.16 ± 1.55 years, with 92% reporting no formal nutrition education. While 90% correctly identified carbohydrates as the primary energy source, only 2% recognized that fat provides the highest energy density. Significant misconceptions existed regarding sports nutrition: 74% incorrectly believed that consuming protein 2–4 h before an event enhances performance, and only 17% knew the recommended pre-event carbohydrate intake. Food choices were primarily influenced by cravings (80%) and sensory appeal rather than health considerations (20%). The digital intervention demonstrated extremely low engagement, with minimal participation in meal photo uploads. Conclusions: This study reveals critical gaps in both general and sports-specific nutritional knowledge among adolescent soccer players in Tunisia, providing important descriptive information about knowledge distribution in this population. While knowledge deficits are substantial, it is important to acknowledge that this cross-sectional assessment documents only knowledge patterns, without measures of actual dietary intake or athletic performance. The persistent misconceptions and the low feasibility of the digital intervention provide important lessons regarding technology-based approaches to nutrition education in this age group, highlighting challenges in sustained engagement that must be addressed in future intervention design.

Introduction: Artificial intelligence (AI) is transforming healthcare systems and medical education worldwide. However, data on medical students’ usage patterns, perceptions, and motivation toward AI remain limited in Tunisia. This study aimed to assess these three dimensions among medical students at the Faculty of Medicine of Sousse. Methods: A cross-sectional study using cluster (session-based) sampling was conducted among medical students (pre-clinical, clinical/extern, and internship years) at the Faculty of Medicine of Sousse during the 2024–2025 academic year. The minimum required sample size, calculated using the Schwartz formula (expected proportion 50%, 5% margin of error, 95% confidence level), was 384 students. Data were collected using a paper-based self-administered questionnaire distributed during tutorial sessions for externs and clinical rotations for interns. Univariate analyses (Chi-square, Fisher’s exact test) and multivariate stepwise binary logistic regression were performed. Statistical significance was set at p < 0.05. Results: A total of 495 students participated, exceeding the calculated minimum sample size, with a mean age of 21.96 ± 1.77 years and 55.6% females. Most students (81.0%) were familiar with AI, and 90.5% reported using it, mainly for research (87.1%), exam preparation (57.0%), and writing tasks (52.1%). The mean perception score for AI in medical education was 5.04 ± 2.01/10, with 34.5% classified as positive. For clinical practice, the mean score was 2.40 ± 1.10/5, with 45.5% positive perception. Fear of dehumanization was reported by 72.3%, and only 15.2% believed AI would improve diagnostic accuracy. The mean motivation score was 28.53 ± 5.17/45, with 45.0% showing high motivation. In multivariate analysis, high frequency of AI use was the factor most consistently associated with these outcomes across all models (ORa: 1.73–6.47, p < 0.05). Female gender was associated with positive perception in education (ORa = 1.73, p = 0.030) and higher motivation (ORa = 3.35, p < 0.001). Conclusions: This first Tunisian study shows that medical students have widely adopted AI, with 90.5% currently using AI in their learning activities. Perceptions remain mixed, with low trust in AI-generated content despite high usage and strong demand for training. Frequency of use is the factor most consistently associated with positive perception and motivation, highlighting the importance of structured, supervised, hands-on AI education in medical curricula.