Over the past few decades, the profile of liver diseases in Africa and the Middle East has undergone significant changes. The incidence of metabolic dysfunction-associated fatty liver disease (MAFLD) has risen to alarming levels. Despite the seriousness of the situation, there is a scarcity of local or regional guidelines established to address it. This document presents the clinical practice guidelines from the African Middle East Association of Gastroenterology (AMAGE) related to the screening, diagnosis, and management of MAFLD. It addresses multiple aspects of managing this condition while taking into account local circumstances and the healthcare system's management requirements. These guidelines are intended for routine clinical use, with a specific focus on particular groups when needed.
INTRODUCTION:Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome (ACS) but remains insufficiently characterized. This study aimed to evaluate early and long-term outcomes of patients with SCAD. METHODS:A national wide, 25-year (since 2000), study with prospective (since 2017) inclusions of patients presenting for ACS with documented SCAD. Primary endpoint was in-hospital and long term major adverse cardiac and cerebrovascular events (MACCE). RESULTS:87 patients. Mean age 47.5±11 years, 71% female, 84% had no or only one conventional cardiovascular risk factor. Pregnancy-associated (P-SCAD) accounted for 9%. ST-segment elevation myocardial infarction and cardiogenic shock were described in 51% and 7%. 101 SCAD lesions (60% type 1, 37% type 2 and 3% type 3) were noted. Left anterior descending was the most affected vessel (72%), multivessel involvement was observed in 26% and severe tortuosities were reported in 38%. Conservative strategy was possible in 84% of patients; among them 15% required subsequent urgent clinically driven revascularization. Coronary angiography and percutaneous interventions were associated with five major complications of which one was fatal. Six in-hospital deaths were reported (7%), 4 of them were P-SCAD. After 16-month median follow-up, overall major events and mortality rates were 17% and 9% respectively. Two SCAD recurrences were reported. CONCLUSIONS:SCAD affected a middle-aged, predominantly female population, with no or few conventional risk factors. In-hospital mortality was high especially in P-SCAD. Coronary angiography and interventions for SCAD were associated with frequent complications, and a conservative management should be preferred when possible.
Introduction:To ensure compliance with new laboratory standards, it is imperative to adopt risk-based thinking, which involves a systematic examination of the functions, procedures, and activities associated with risks and opportunities. This article aims to explore the implementation of risk-based thinking in medical biology laboratories and to highlight the challenges inherent in this approach. Materials and Methods:This descriptive study was conducted in the biochemistry laboratory of the Main Military Teaching Hospital of Tunis during the first half of 2024. A risk analysis was performed by a working group to identify failures by analyzing non-conformities recorded during the study period. The group adopted the Failure Mode and Effects Analysis (FMEA) methodology, an inductive approach well-suited to process analysis and mastered by all participants. Subsequently, a corrective action plan was developed for each process phase. Results:Across the entire laboratory workflow, 33 distinct failure modes were identified and cataloged for each step, followed by a criticality analysis. The distribution of these failures was 36.36% in the pre-analytical phase, 33.34% in the analytical phase, and 30.3% in the post-analytical phase. A review of the severity of their effects revealed that a significant portion constituted major risks. Conclusion:In response to the major risks identified at each stage of the laboratory workflow, a corrective action plan has been proposed. This plan outlines specific actions designed to reduce the criticality of these risks and enhance patient safety and quality of service.
BACKGROUND:This study aimed to determine the prevalence of carbapenem-resistant Enterobacterales (CRE), to characterize their molecular resistance mechanisms, and to assess associated clinical outcomes among intensive care unit (ICU) patients in Tunisia. METHODS:A cross-sectional study was conducted from January to March 2025 in the ICU of Habib Thameur Hospital and included all patients with clinically significant CRE infections. Resistance determinants were identified using multiplex polymerase chain reaction with reverse dot blot hybridization. RESULTS:Among 95 ICU admissions, 17 patients developed CRE infections, corresponding to an incidence density of 21.6 cases per 1,000 patient-days. All infections were hospital-acquired. The most frequent risk factors were the presence of central venous and urinary catheters (16 patients each) and mechanical ventilation (15 patients). Klebsiella pneumoniae predominated, accounting for 26 of 27 isolates, all of which were multidrug-resistant (MDR), with a median antibiotic resistance index of 1.00. The blaNDM and blaOXA-48 genes were detected in 81.5% and 77.8% of isolates, respectively, with 70.4% co-producing both carbapenemases. All K. pneumoniae isolates harbored blaSHV and/or blaCTX-M, while a single Escherichia coli isolate carried blaOXA-48. Cluster analysis revealed strong associations between β-lactamase production and resistance to aminoglycosides and fluoroquinolones, suggesting co-selection of MDR strains. Empirical antimicrobial therapy was appropriate in only 47% of cases, and ICU mortality reached 82.4%. CONCLUSION:These findings highlight an alarmingly high burden of CRE infections in this ICU, driven mainly by K. pneumoniae co-producing NDM and OXA-48, and underscore the urgent need for strengthened infection control and antimicrobial stewardship strategies.
