Abstract Objective: To assess temporal trends in hospital-acquired infections (HAIs) prevalence, antimicrobial resistance (AMR) patterns, and associated risk factors of multidrug resistance (MDR)-related HAI in a Tunisian hospital between 2023 and 2025. Design: Repeated point-prevalence surveys (PPSs). Setting: Sahloul University Hospital, Sousse, Tunisia. Patients: All patients hospitalized for more than 48 hours during each surveys. Methods: Data on HAI prevalence, isolated pathogens, and AMR profiles were collected through three PPSs conducted annually from 2023 to 2025. HAIs were defined according to the criteria of the Centers for Disease Control and Prevention. MDR was defined as nonsusceptibility to at least one agent in three or more antimicrobial classes. Results: From 2023 to 2025, 126 pathogens were responsible for 101 HAIs among 752 surveyed patients. The overall HAI prevalence was 10.9%, with no significant difference between the survey years (trend P = .430). Bloodstream infections were the most common type of HAI. Microbiological documentation was available for 94% of cases. Gram-negative bacteria predominated (72.2%) with Klebsiella pneumoniae (15%) as the leading pathogen. Overall, 41.2% of isolates were classified as MDR, with no significant trend over time (trend P = .068). Enterobacterales resistant to third-generation cephalosporins accounted for 14.3% (18/126) and carbapenem-resistant Enterobacterales for 7.9% (10/126). Prolonged hospital stay (>8 d) and ICU admission were independently associated with MDR-related HAIs (adjusted OR = 15.759, 95% CI: 3.691–67.285, P < .001 and OR = 3.612, 95% CI: 1.584–8.237, P = .002). Conclusions: Repeated PPSs are an effective surveillance strategy for monitoring HAIs and AMR. These findings support the implementation of targeted antimicrobial stewardship and enhanced infection control interventions in Tunisian hospitals.

The hospital environment is a recognized reservoir for multidrug-resistant (MDR) bacteria, and inadequate hygiene practices by healthcare workers (HCWs) may contribute to the transmission and persistence of healthcare-associated infections (HAIs), particularly in ICUs. This study investigated the presence, genetic characteristics, and transmission pathways of MDR Enterobacterales in the environment and among HCWs in three ICUs, such as surgical (ICU-S), medical (ICU-M), and pediatric (ICU-P), at Sahloul Hospital, Sousse, Tunisia. From September to December 2020, 140 samples were collected from environmental surfaces (n = 114) and HCWs' hands (n = 26). Of these, nine samples (6.42%) tested positive for resistant Enterobacterales, yielding 15 resistant isolates, including one Klebsiella pneumoniae and eight Enterobacter cloacae. Notably, no resistant Enterobacterales were recovered from HCWs' hand samples. Whole-genome sequencing was performed on seven isolates (five clinical and two environmental) to assess genetic relatedness and resistance profiles. Three distinct sequence types (STs) of K. pneumoniae were identified: ST147 (clinical and environmental), ST307, and ST353. The ST147 isolate from an antiseptic bottle in ICU-M co-produced CTX-M-15 and NDM-1 enzymes and carried the biocide resistance gene qacE. Despite both being ST147, the environmental and clinical isolates were not clonal (140 single-nucleotide polymorphism (SNP) differences). The ST307 isolate from a blood sample co-produced CTX-M-15 and OXA-204. Among E. cloacae isolates, ST344 (n = 2) was identified from two different ICUs and differed by only 6 SNPs, suggesting inter-ICU transmission. These isolates harbored blaACT-16, blaCTX-M-15, and multiple other resistance genes. One environmental E. cloacae isolate belonged to the clone ST78 and was recovered from a soap dispenser in ICU-P, carrying blaACT-15 and fosA. These findings underscore the potential of contaminated surfaces to harbor and disseminate MDR Enterobacterales. Strengthened infection control measures, environmental monitoring, and genomic surveillance are essential to reduce HAIs in ICU settings.

On July 27th and 29th, 2022, the Prevention and Safety of Care Department at Sahloul University Hospital was alerted to an outbreak of invasive infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP). The infections were reported in three departments: Post Serious Operations (PSO), Surgical Resuscitation, and Orthopedics. This case study examines the outbreak, focusing on the epidemiological investigation, environmental The teaching approach involves a systematic methodology for conducting outbreak investigations and implementing infection control strategies in a university hospital. Students will describe cases by time, person, and place, and prepare synoptic charts. They will also evaluate adherence to standard hygiene precautions and interpret data from figures and tables, leading to recommendations for corrective actions. This epidemic involved three cases of patients with intrinsic (comorbidities) and extrinsic (invasive procedures: gastrostomy, vascular catheterization, urinary catheter) risk factors. The three isolated strains had the same antibiotype characterized by resistance to all antibiotics except Fosfomycin and colistin. The environmental survey didn´t monitor any Klebsiella pneumoniae in the three patients´ environments. From the six criteria of the standard hygiene precautions, 16 observations were tested in the audit, from which (10; 62.5%) were respected in the Surgical Resuscitation department, (8; 50%) in the PSO department and (2; 12.5%) in orthopedic department. This investigation highlights the need for a proactive surveillance system and strict adherence to infection control measures to prevent the spread of CRKP.

Background: This study aimed to determine the prevalence of hospital-acquired infections (HAIs), identify associated risk factors, and describe the microbiological profile of HAIs in a university hospital (UH) in central Tunisia during 2025. Methods: A prevalence study was conducted at a UH in Sousse, central Tunisia. Following the Centers for Disease Control and Prevention definitions, all infections occurring more than 48 hours after hospital admission were classified as HAIs and included in the study. Data collection included a one-day survey per department and a six-day prevalence assessment. Baseline characteristics, clinical features, isolated pathogens, and antimicrobial resistance profiles were recorded. Results: Among 255 eligible patients, 29 had at least one HAI, yielding a prevalence of 11.4%. Bloodstream infections and pneumonia were the most frequent HAIs (32.4% each). Gram-negative bacteria represented 67.4% of all isolates, with Klebsiella pneumonia and Acinetobacter baumannii being the most common (15.2% each). More than half of the isolates (59.4%) were multidrug resistant, including 53.8% of non-fermentative Gram-negative bacilli resistant to carbapenems and 73.3% of Enterobacterales resistant to third-generation cephalosporins. Multivariate analysis showed that prolonged hospital stay (> 10 days) was identified as an independent risk factor for HAIs (AOR = 8.08, 95% CI: 2.54-25.67, p< 0.001). Conclusions: Our findings indicate a high prevalence of HAIs and MDR pathogens. Strict adherence to infection control measures, combined with the implementation of an antibiotic stewardship program at the regional and national levels, is crucial to reducing infections and limiting the emergence of resistant strains.

BACKGROUND:Continuing Medical Education (CME) is essential for updating the competencies of healthcare professionals. As part of a quality improvement initiative, the CPD committee at the Faculty of Medicine of Sousse evaluated the 2021-2022 programs. The study aimed to assess learner satisfaction by distinguishing overall subjective satisfaction from criterion-based evaluation (based on specific quality criteria like resources and pedagogy). This approach identifies whether a positive general feeling masks structural deficiencies in course design. METHODS:We conducted a cross-sectional study over a five-week period using a structured evaluation grid distributed via Google Forms. The evaluation covered all three phases of the CME process (before, during, and after the course). For each criterion, participants selected one of four options ranging from "unsatisfied" to "satisfied." Criterion-based evaluation was assessed via an overall rating from 1 to 5, with a score ≥4 indicating satisfaction. Correlation between overall subjective satisfaction and criterion-based evaluation was analyzed. RESULTS:A total of 268 responses were collected. Women predominated (73.1%). The mean age was 36 ± 8 years, and most participants practiced in urban areas (91%) and at the tertiary care level (55.6%). The overall mean satisfaction score was 3.8 ± 1.02, with 69.4% of participants classified as satisfied. Overall subjective satisfaction was significantly associated with criterion-based evaluation across all criteria. In addition, overall subjective satisfaction was associated with age (p = 0.007), years in current practice (p = 0.043), academic affiliation (p = 0.008), specialty (p = 0.019), and type of CME (p = 0.003). CONCLUSION:Learner satisfaction with CME activities was correlated with factors such as specialty, academic affiliation, experience, age, and CME format. These findings support recommendations to tailor CME content to participant profiles, emphasize practical training, ensure timely delivery of resources, and improve advance communication of schedules to enhance program effectiveness.

INTRODUCTION:Hospital-acquired infections (HAI) represent a growing public health concern and are the most common adverse events in healthcare delivery. Improvements in infection prevention and control (IPC) practices at both national and facility levels are decisive for  successfully preventing HAIs. The relevance of IPC in preventing the spread of disease was underscored during the COVID-19 pandemic. However, the impact of COVID-19 preventive measures on HAIs remains debated. AIM:This study aims to investigate the impact of the IPC program implemented during the COVID-19 pandemic at Sahloul University Hospital in Tunisia on the prevalence of HAIs. Additionally, the study will assess compliance with IPC measures during the same period. METHODS:A pre-interventional study design will be conducted at Sahloul University Hospital in Sousse, Tunisia. The study will compare HAI prevalence over three periods : pre-pandemic (2019), during the pandemic (2020) and post-pandemic (2022). For the Point prevalence srvey, all hospital wards (units or departments) will be included in the survey, except the emergency department, hemodialysis unit and endoscopy units. Four key IPC program criteria will be analyzed: hand hygiene compliance, environmental cleaning, sanitary waste management, and the consumption of personal protective resources, including alcohol-based hand sanitizer, surgical masks and disposable gloves. Expected results : This study specifically explores the effects of IPC measures implemented during the COVID-19 pandemic on HAIs prevlance. Its findings are expected to contribute valuable insights into sustainable strategies for maintaining high compliance rates and reducing HAI prevalence beyond crisis periods.

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.

ObjectivesWe aimed to determine the prevalence of dental caries and its associated factors among primary school children in Tunisia.MethodsA cross-sectional study was conducted among children enrolled in primary schools in Sousse, Tunisia, in April 2022. A systematic random sampling technique was used. A structured questionnaire and medical records were used to collect data. A multivariate analysis was performed using binary logistic regression to identify factors independently associated with dental caries.ResultsIn total, 376 children were included. The prevalence of dental caries was 43.9%. Based on a bivariate analysis, many factors were associated with dental caries, such as children from public schools (p < 0.001), lack of tooth brushing (p < 0.001), tooth brushing only 1 time per day (p < 0.001), unhealthy eating habits (p ≤ 0.05), and overweight body mass index (p = 0.016). In multivariate analysis, risk factors for dental caries were age and eating after brushing in the evening, whereas protective factors included frequent tooth brushing and regular toothbrush replacement.ConclusionsWe recommend organizing awareness days in schools, implementing programs on preventive measures against dental caries, and expanding screening campaigns.

Background:During the coronavirus disease 2019 (COVID-19) pandemic, strict infection prevention and control (IPC) measures were implemented in healthcare settings. Aim:To evaluate the effect of enhanced IPC practices implemented during the COVID-19 pandemic on the prevalence of hospital-acquired infections (HAIs) in a Tunisian university hospital. Methods:A multimodal IPC strategy was implemented from March to September 2020 at Sahloul University Hospital, Sousse, Tunisia. This strategy included promoting hand hygiene (HH), enhancing adherence to standard precautions and universal masking. We compared the prevalence of HAIs and compliance with IPC practices before the pandemic (pre-intervention phase) and during the pandemic (post-intervention phase). Results:A total of 306 patients were surveyed in 2019 and 228 in 2021. The prevalence of HAIs increased slightly from 9.4% to 10.08% (p = 0.814). HH compliance improved significantly from 38.3% to 51.6% and sharp waste sorting compliance rose from 60.3% to 77.6%. The use of personal protective equipment also increased, with FFP2 respirator consumption increasing nearly 247-fold. Conclusions:This study found no significant change in HAI prevalence despite the implementation of enhanced IPC strategies. However, the small sample size was a major limitation that may have reduced the statistical power to detect meaningful differences. Larger-scale studies are needed to confirm these findings and better assess the impact of IPC strategies in this context. Trial registration:Not applicable.

Abstract Introduction Tooth decay is considered the fourth most important public health problem in the world. According to the latest studies, the prevalence of this disease is also important in school children. The interest of this work is to study the prevalence of dental caries and its influencing factors in primary school children in the city of Sousse (Tunisia) and to formulate recommendations for the prevention of this phenomenon. Methods It is a cross-sectional study conducted among pupils enrolled from 1st and 3rd grade of 3 primary schools in the city of Sousse in April 2022 through a questionnaire filled out by the pupils. Results A total of 376 participated in the study. Among them, 52,4% were male. The mean age was 7.4 ± 1.2 years. The prevalence of dental caries in our population was 43.9%. Many factors were associated with dental caries including pupils from public schools (p = 0.000), poor oral hygiene: [lack of tooth brushing (p = 0.000), tooth brushing only 1 time per day (p = 0.000), eating in the evening after brushing the teeth (p = 0.000), lack of changing the toothbrush (p = 0.000)] and unhealthy eating habits (p ≤ 0.05). Consequently, dental caries was significantly higher among children with overweight body mass index (BMI) (90.9%; p = 0.016). Conclusions The organization of awareness and information days in schools, the integration of an education program on preventive measures against this phenomenon and the generalization of screening campaigns to detect this disease are necessary measures that should be carried out according to a well determined strategy. Key messages • Dental caries prevalence among primary school children in Sousse is significant, highlighting the urgent need for preventive measures. • Factors such as poor oral hygiene, unhealthy eating habits, and attending public schools contribute to the prevalence of dental caries.

OBJECTIVE:Since 2009, the unit of smoking cessation at Sahloul University Hospital - Tunisia was founded. In this context, the objective of our study was to determine the factors associated with smoking cessation in Tunisian smokers. METHODS:It was a descriptive prospective study over five-years-period 2015-2020. We included all patients who willingly came to the anti-smoking consultation of the Sahloul University hospital Sousse Tunisia. Data were collected during the consultation of all patients. We proceeded to a univariate and then multivariable analysis to identify the predictive factors of smoking cessation. RESULTS:Over 5 years, we included 450 patients, mainly males (91.3%). The average age of the consultants was 46 ±15.58 years. The average age of the first cigarette among our patients was 16.83± 4.34 years. The likelihood of smoking cessation was higher among males (p=0.004, OR=9.708), patients attending minimum 3 anti-smoking consultations (p<10-3, OR=5.714), patients benefiting from nicotine replacement therapy (p=0.034, OR=2.123), with high motivation score for smoking cessation (p=0.001, OR=1.980) and with an advanced age of the first cigarette (p<10-3, OR=1.096). However, the likelihood of smoking cessation was lower among coffee and alcohol consumers (p=0.002, OR=0.252) and smokers with less than 5 years smoking habit (p=0.011, OR=0.069). CONCLUSION:Although the decision to stop smoking is a personal one, it requires medical and psychological support as highlighted by our findings. Our study showed that assiduity and medical assistance for tobacco cessation increase smokers' chances of quitting.

Introduction Adverse events (AEs) that occur in hospitals remain a challenge worldwide, and especially in intensive care units (ICUs) where they are more likely to occur. Monitoring of AEs can provide insight into the status and advances of patient safety. This study aimed to examine the AEs reported during the 20 months after the implementation of the AE reporting system. Methods We conducted a retrospective analysis of a voluntary ICU AE reporting system. Incidents were reported by the staff from ten ICUs in the Sahloul University Hospital (Tunisia) between February 2020 and September 2021. Results A total of 265 reports were received, of which 61.9% were deemed preventable. The most frequently reported event was healthcare-associated infection (30.2%, n = 80), followed by pressure ulcers (18.5%, n = 49). At the time of reporting, 25 patients (9.4%) had died as a result of an AE and in 51.3% of cases, the event had resulted in an increased length of stay. Provider-related factors contributed to 64.2% of the events, whilst patient-related factors contributed to 53.6% of the events. As for criticality, 34.3% of the events ( n = 91) were unacceptable (c3) and 36.3% of the events ( n = 96) were ‘acceptable under control’ (c2). Conclusions The reporting system provided rich information on the characteristics of reported AEs that occur in ICUs and their consequences and may be therefore useful for designing effective and evidence-based interventions to reduce the occurrence of AEs.

Objectives. - The standard process of central sterilization is crucial for the optimal functioning of the operating room. The outcome of this process is closely linked to the steps preceding the steps prior to the sterilization step itself. These steps include pre-disinfection carried out in the operating rooms and other stages, namely washing, drying and packaging, which must be performed in the central sterilization unit. In this context, this study aimed to describe the knowledge of the staff in the operating rooms and the central sterilization unit at Sahloul University Hospital in Sousse (Tunisia) in 2022, regarding the steps prior to the sterilization of reusable thermoresistant medical devices and to describe their practices in terms of compliance with these steps. Method. - A descriptive study was conducted from January 2022 to June 2022 with the aforementioned staff, using a self-administered questionnaire to assess their knowledge of the pre-sterilization steps and a direct observation audit of their practices with regard to these steps. Both measurement instruments were pre-tested. Results. - Out of 102 self-administered questionnaires (knowledge assessment) distributed to the staff concerned, only 80 were returned and correctly filled out, giving a response rate of 78.4%. Participants' responses regarding the order of steps prior to the sterilization were incorrect in 64% of cases. With regard to the evaluation of professional practices, 224 observations were made in the study area (practice audit). In 82% of these observations, the pre-disinfection step was confused with the washing step. The use of Betadine brushes and scrubbing pads for device washing was noted in 89.3%, along with the absence of swabbing of the canals and hollow parts in 9.4% of cases and the absence of drying of the canals with compressed air. Conclusion. - Mastery of the steps prior to sterilisation of reusable thermoresistant medical devices was insufficient in our institution, suggesting the importance of reinforcing the implementation of the procedure through a continuous training program followed by action plans. (c) 2024 Academie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.

Healthcare waste (HCW) poses a global hazard, particularly in developing country hospitals where mismanagement is common due to poor practices among staff. Training healthcare workers has shown promise in enhancing practices and behaviors. The aim of this study was to assessHCW management at Sahloul University Hospital (2019–2021) before and after training sessions. This study was conducted at Sahloul University in Sousse, Tunisia, spanned two years (2019–2021) and consisted of three distinct stages. Two audits of Healthcare Waste Management (HCWM) were conducted using a predetermined assessment framework derived from ANGED’s guidelines, with an educational session separating the two audits. In terms of sorting practicesthere was a substantial improvement in sorting practices following training. Specifically, the overall compliance rate for sorting sharps increased from 60.3 to 77.6

Abstract Background Healthcare associated infections are a major cause of morbidity and mortality in intensive care units. Observance hand hygiene is singled out as a key element in interruption of these infections. The present study aimed to assess whether hand hygiene intervention program in intensive care unit at the Sahloul University Hospital of Sousse is able to decrease healthcare associated infections. Methods We carried out a pre-experimental study among patients hospitalized in seven intensive care units at the Sahloul University Hospital of Sousse during two distinct periods of 3 months, the first in 2019 and the second in 2021. During these two periods, we monitored only patients hospitalized in the ICU for more than 48 hours and incidence of healthcare associated infections was compared. Healthcare associted infections were defined as infections occurred at least 48 hours after admission to the intensive care units. The hand hygiene promotion intervention, done during the year 2020, was based on 3 axes (training sessions, procedures writing and professional practicesevaluation). Results Incidence of healthcare associated infections decreased significantly in post-intervention (p = 0.000). The decrease of Ventilator-associated pneumonia was significantly higher than other types of infections(p = 0.042). Extended Spectrum B-Lactamase Producing Enterobacteriaceae infections and Ceftazidim resistant Pseudomonas Aeruginosa infections decreased significantly in after intervention (p = 0.000). Conclusions The results of our study showed that improved hand hygiene resulted in a reduction in healthcare associated infections. Key messages • Observance hand hygiene is singled out as a key element in interruption of healthcare associated infections. • Improved hand hygiene resulted in a reduction in healthcare associated infections.

Abstract Introduction Therapeutic education is a patient-centered, approach aimed at addressing the patient’s needs and resources. It is intended not only to help the patient understand their illness and treatment but also to empower them to become autonomous. So far, in Tunisia, we lack structures for therapeutic education specifically tailored for coronary patients. In this context, we implemented a Therapeutic Education Program (TEP) for coronary patients visiting the cardiology department at Sahloul University Hospital with the aim of assessing the impact of this program in the short, medium (3 months), and long term (12 months). Methods We conducted a quasi-experimental study on TEP for patients with coronary artery disease over one year at Sahloul University Hospital. Patients were divided into two groups, intervention, and control. Outcome measures included major cardiovascular events, improvement in knowledge, and biological indicators, with statistical analysis performed using SPSS in accordance with ethical considerations. Results The study included 129 patients, of whom 38 underwent a therapeutic education program. TEP demonstrated a significant improvement in knowledge about coronary artery disease, with program satisfaction rated ≥8 on a scale of 0 to 10.Our program also showed improvement in biological parameters, particularly lipid profiles, within the educated group before and after 3 months, such as LDL cholesterol levels (2.53 vs 1.88, P < 0.001), and compared to the control group (1.88 vs 2.9, P = 0.001).Moreover, it led to a significant reduction in long-term cardiovascular events compared to the control group (21.1% vs 59.3%, p < 0.001). Conclusions this study underscores the crucial importance of therapeutic education in enhancing the care and quality of life of coronary patients, highlighting its central role in a proactive, personalized approach to medical management. Key messages • The significance of therapeutic education in empowering patients to understand their condition and become self-reliant. • Need for Structured Programs specifically for coronary patients in Tunisia.

Background Tunisia was one of the most affected nations with COVID-19 disease. The clinical features of this illness range from asymptomatic illness to death. Aim To analyse the survival of patients admitted to a Tunisian tertiary care center (Sahloul University Hospital) and identify independent predictive factors for hospital COVID-19 mortality. Methods A longitudinal study was conducted among confirmed COVID-19 patients hospitalized in Sahloul University Hospital between September 2020 and September 2022. Cox univariate regression was used to calculate the Hazard Ratio (HR) of death for patient characteristics regarding the time at risk. Risk factors with a p value of 0.2 or less in the univariate analysis were initially included in the multivariate Cox regression models. Results During the study at Sahloul Hospital, 1978 patients were hospitalized, averaging 55.65 years in age (± 21.39). Among them, 417 deaths occurred, with a median survival of 30 days (± 3.11) [23.904-36.096]. Factors significantly affecting the survival curve were: Age, male gender, comorbidities, diabetes, hypertension, endocrine diseases, obesity, intubation, and ICU admission Multilevel survival analyses revealed that hypertension (aHR 1.24; CI [1.02-1.52]; p=0.028), ICU admission (aHR 12.20- CI [9.56-15.57]; p<10-3), and male gender (HR 1.19; CI [0.98-1.46]; p=0.076) were independent factors associated with COVID-19 mortality. Conclusion Our study concluded the importance of the early identification of high-risk COVID-19 patients to decrease this virus mortality. A good understanding of the possible clinical factors associated with COVID-19 severity is helpful for clinicians in identifying patients who are at high risk and require prioritized treatment to minimize death.

Background Pulmonary echinococcosis in children has frequent and severe complications. The aim of our study was to determine predictive factors of pre and postoperative complications of pediatric pulmonary hydatid cyst. Methods We conducted a retrospective descriptive and analytic study conducted from January 2010 to December 2018. The study population was divided into two groups to determine predictive factors of pre- and post-operative complications of pediatric pulmonary echinococcosis. Data were analyzed by IBM SPSS 21.0. A p-value of 0.05 was accepted as significant. Results The study included 106 boys and 94 girls with a median age of 8 years. One hundred and thirty-eight patients (69%) had complicated pulmonary hydatid cyst preoperatively. Univariate analysis identified 12 predictive factors of pre-operative complications: rural origin (p=0.0001), hydatid contact (p<0.001), long period between the onset of symptoms and the first medical consultation (p=0.0001), the autumn and the winter (cold seasons) (p=0.0001), chest pain (p=0.0001), hemoptysis (p=0.023), fever (p=0.0001), right side (p=0.01), apical and para hilar location (p=0.01), superior lobe (p=0.05), superior right lobe (p=0.0001), cyst size>5cm (p=0.02), positive hydatid serology (p<0.0001). It identified 2 predictive factors of post-operative complications: giant cyst (p=0.009) and not performing a capitonnage (p=0.016). Multivariate analysis showed 4 independent pre-operative predictive factors of complications: rural area (p<0.0001), fever (p=0.006), right side (p=0.02) and positive hydatid serology (p<0.001). It identified 2 postoperative independent predictive factors of complications: not performing.capitonnage (p=0.029) and solitary hydatid pulmonary cyst (p=0.02). Conclusion Pulmonary hydatid cyst management in children needs a thorough appreciation of independent predictive factors of pre and postoperative complications in order to reduce their morbidity.