Hôpital Razi de La Manouba

Neuromyelitis optica spectrum disorder (NMOSD) is a severe autoimmune disorder affecting the central nervous system, often misdiagnosed as multiple sclerosis. The identification of aquaporin-4-IgG (AQP4-IgG) has improved diagnostic precision and enabled targeted therapies. Given the unique regional challenges in healthcare delivery across the Middle East and North Africa (MENA) region, the Middle East and North Africa Committee for Treatment and Research in Multiple Sclerosis (MENACTRIMS) convened an expert panel to develop evidence-based, region-specific consensus recommendations for diagnosis and management. These guidelines endorse the 2015 International Panel for NMO Diagnosis (IPND) criteria, emphasizing AQP4-IgG testing via cell-based assays. Differential diagnosis should consider multiple sclerosis, myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), and acute disseminated encephalomyelitis (ADEM). For acute treatment: initiate high-dose intravenous methylprednisolone promptly and use plasma exchange early for severe or steroid-refractory attacks. For long-term immunotherapy, monoclonal antibodies (rituximab, inebilizumab, eculizumab, ravulizumab, satralizumab, or tocilizumab) are recommended according to availability and patient factors; conventional immunosuppressants remain alternatives when biologics are inaccessible. Guidance is provided for pediatric patients and for pregnancy and breastfeeding, including planning after ≥ 12 months of disease stability and early postpartum treatment resumption. These MENACTRIMS guidelines aim to improve NMOSD outcomes across the region by promoting accurate diagnosis and timely, effective therapy.

One of the challenges post-COVID-19 is reducing the negative impacts on quality of life, performance, and independence in activities of daily living. Assessing functional dependence in adults one year after acute infection can help to understand the long-term consequences, evaluate the impact on quality of life, plan rehabilitation and healthcare, identify the most vulnerable groups, measure the socioeconomic impact, and support public policies and clinical decisions. Objectives: The objectives of this study are as follows: (a) to assess the prevalence of functional dependence in Brazilian adults with COVID-19; (b) to analyze the association between the study variables; and (c) to determine the factors associated with functional dependence. Methods: This was an observational, cross-sectional study with 987 adults (18 to 59 years old) living in the State of Paraná (Brazil) hospitalized for COVID-19 between March and December 2020. Data were collected by telephone 12 months after the acute infection using an instrument to retrieve sociodemographic and health information, and a functional dependence scale to assess dependence before COVID-19 retrospectively (using participant recall information) and at the time of the interview. Data were analyzed using penalized logistic regression after imputing missing data. Data were analyzed using penalized logistic regression after imputing missing data. Results: Functional dependence after COVID-19 was 5.0% and was associated with low levels of education, not having a partner, living with someone, not owning a home, experiencing job changes, requiring care, obesity, smoking, multimorbidity, ICU admission in the acute phase, use of invasive ventilation, or having Long COVID. Individuals who required care or used invasive ventilation support were, respectively, 9.3 and 6.5 times more likely to develop dependence after COVID-19. Despite adjustment for multiple factors, the magnitude of the observed effects warrants cautious interpretation, as unmeasured or residual confounding effects may still be present. Sample recall bias due to collection after 12 months and the presence of the alpha variant without COVID-19 vaccination coverage may limit data generalization. Conclusions: The results highlight the need to emphasize the public health implications of identifying functional dependence. In this vein, it is necessary to implement preventive measures, identify and monitor more vulnerable groups, plan rehabilitation programs, and develop public health policies.

The role of research in renewing practices is becoming increasingly important. In its 145th issue, Glossa explores increasingly challenging topics, such as the role of assessment in clinical practice and speech-language pathology, and the importance of clinical reasoning. Other themes include the validity and adaptation of tools, with a detailed analysis of psychometric quality, linguistic context characteristics, and tool adaptability. Additionally, the issue addresses linguistic diversity and population representativeness, emphasising both intra- and interlinguistic variability.

Background Endometrial malignancy in premenopausal women with abnormal uterine bleeding (AUB) is rare but clinically challenging. Current diagnostic strategies rely on endometrial sampling, which is invasive and often unnecessary. This study aimed to develop and internally validate a novel risk prediction score for endometrial malignancy in premenopausal women with AUB. Methods A retrospective longitudinal analytical study was conducted over 8 years and 11 months (January 2016–November 2024) at Charles Nicolle Hospital, Tunis, Tunisia. Premenopausal women with AUB who underwent endometrial biopsy followed by hysterectomy were included. Comparative analyses, logistic regression, and ROC curve analysis were performed. Significant variables were weighted according to adjusted odds ratios to construct a risk prediction score. Results Among 209 patients, 13 (6.2%) had endometrial malignancy. Independent predictors of endometrial malignancy were: oral contraceptive use (OR 29.9, 95% CI 1.5–587.1, p = 0.025), endometrial thickness >9 mm (OR 25.3, 95% CI 4.3–147.6, p < 0.001), vascularization (OR 98.3, 95% CI 3.7–2594.8, p = 0.006). Protective factors included hemorrhage episode ≤1 (OR 0.20, 95% CI 0.08–0.52, p = 0.001) and lower bleeding abundance (OR 0.30, 95% CI 0.13–0.65, p = 0.002). The final score allocated points as follows: endometrial thickness >9 mm (+3), oral contraceptive use (+3), vascularization (+4), hemorrhage episodes ≤1 (−2), and lower bleeding abundance (−1). A score ≥7 defined high risk. Model discrimination was excellent (AUC 0.901, 95% CI 0.825–0.976, p < 0.001). At a cutoff ≥7, sensitivity was 77%, specificity 90%, positive predictive value 34%, and negative predictive value 98%. Conclusions We developed and internally validated a novel risk prediction score for endometrial malignancy in premenopausal women with AUB. With strong diagnostic performance and high negative predictive value, this score may help clinicians better identify women who truly require invasive sampling.

BackgroundSleep disturbances are common among patients with systemic lupus erythematosus (SLE) and significantly impair quality of life. Despite increasing awareness, determinants of poor sleep in this population remain underexplored.ObjectivesThis study aimed to assess sleep quality in Tunisian SLE patients and identify associated clinical and psychological factors.MethodsA cross-sectional study was conducted at Rabta Hospital in Tunisia from February to May 2023, including 100 SLE patients fulfilling the 2019 EULAR/ACR classification criteria. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Depression, anxiety, fatigue, pain, and quality of life were assessed using validated Arabic versions of the Hospital Anxiety and Depression Scale, Fatigue Severity Scale, Numeric Pain Rating Scale, and Lupus QoL.ResultsPoor sleep quality (PSQI ≥6) was observed in 58% of participants. Univariate analysis revealed associations between poor sleep and older age, family history of SLE, depression, anxiety, fatigue, moderate-to-severe pain, and disease activity. However, multivariate analysis identified emotional health domain as the sole independent predictor of poor sleep (OR = 0.955; p = .03).ConclusionEmotional health emerged as a key determinant of sleep quality among SLE patients in Tunisia. These findings highlight the need for integrated psychosocial interventions to improve both sleep and overall quality of life. Future longitudinal studies are needed to confirm these associations and assess causal relationships.