Institut des Hautes Études de Tunis

L’apoplexie pituitaire (AP) est une complication relativement rare des adénomes hypophysaires (AH), survenant sous forme de nécrose ou d’hémorragie au sein de la tumeur. L’objectif de cette étude était de déterminer les facteurs prédictifs de survenue d’apoplexie pituitaire chez les patients présentant une AH. Il s’agissait d’une étude rétrospective comparative incluant 40 patients suivis à l’hôpital militaire de Tunis pour macroadénome hypophysaire dont 18 cas compliqués d’AP (groupe 1) et 22 patients indemnes de cette complication (groupe 2). La prédominance était féminine dans les deux groupes. Les moyennes d’âge et d’indice de masse corporelle (IMC) étaient respectivement de 44 ans et 31 kg/m 2 dans le groupe 1 et de 42 ans et 30 kg/m 2 dans le groupe 2. Ces paramètres n’étaient pas corrélés au risque d’AP ( p = 0,63 pour l’âge ; p = 0,9 pour l’IMC), de même pour la multiparité ( p = 0,5). Par ailleurs, la taille de la tumeur n’était pas corrélée au risque d’apoplexie ( p = 0,41) ainsi que la nature de la sécrétion tumorale ( p = 0,3). En analyse univariée, l’apoplexie était associée aux céphalées ( p = 0,025) et aux troubles visuels ( p = 0,007). En analyse multivariée, les troubles visuels présentaient un facteur de risque d’apoplexie ( p = 0,025) avec OR à 15,2. Le risque d’apoplexie était comparable chez les patients présentant ou non une insuffisance thyréotrope ( p = 0,17) et/ou corticotrope ( p = 0,3) et/ou gonadotrope ( p = 0,095). Les céphalées et les troubles visuels sont très fréquents au cours de l’apoplexie hypophysaire. Néanmoins, notre étude montre que les troubles visuels sont le seul paramètre hautement prédictif du risque de survenue de cette complication.

Abstract Regional anesthesia (RA) is increasingly used in intensive care in Tunisia, but challenges persist to ensure optimal practice. We conducted a multicenter study involving post-operative and polyvalent intensive care units, both private and public. Resident physicians(44.7%) are sensitized to quality of care, but gaps remain. Attending physicians (63.3%) often report the absence of pain management committees (PMCs) and written protocols for RA. The majority express a need for continuous training, particularly on RA. High-fidelity simulation is the preferred format for learning. RA is commonly used in intensive care (97.2%), mainly epidural (76.4%) and femoral nerve blocks (54.9%). Ultrasound is widely preferred for guiding procedures (77.5%). The main areas of RA application are thoracic (94.4%) and limb trauma (64.8%). The ANI is the preferred pain monitoring tool (49.3%). Improving training and infrastructure is necessary for optimal RA practice in intensive care in Tunisia.

Objective- Evaluate the interest of the use of Information and Educational Technologies in the initial training of dental medicine students at the faculty of dental medicine of Monastir. Methods- This was a descriptive study conducted at the FDMM in 2022. Data was collected through a questionnaire. It was composed of four parts and posted beteween May 1st and June 30th, 2022. Results- Of the 253 interns, 208 responded and 177 responsers were retained. The survey participants were connected to the internet almost all the time but 26.1% spent less than 30 minutes a day on their studies, mainly to access online courses or conduct literature research. The principle search engine were Google (93.8%) and Wikipedia (48%); Facebook was the principal social media (91%) used during learning. Almost half of the internal trainees were familiar with e-learning platforms although 72% of them had no previous experience. They preferred online courses to lectures (68.4 %) in order to consult the course at any time. More than 90% of respondents were unaware of MOOCs (Massive Open Online Courses). Conclusion- This study demonstrated the importance of the introduction of the Information and Educational Technologies in the university curriculum.

PurposeThe purpose of this paper is to investigate the effect of equity market misvaluation on manager behavior. Using a sample of 535 French-listed over 2000–2018, the authors analyze whether corporate investment decision is sensitive to equity market overvaluation.Design/methodology/approachThe study adopts market-to-book (M/B) decomposition developed by Rhodes-Kropf and Viswanathan (2004, RKV) that proxies for market misvaluation at the firm and industry levels. The authors conducted a long-term performance analysis via a portfolio sorting procedure and a Carhart (1997) four-factor pricing model. The authors tested the relationship between equity misvaluation, corporate investment decisions and equity issuance. The authors ran several robustness tests.FindingsThe empirical results show that equity market misvaluation affects corporate investment positively as the stock price deviates further away from its fundamental. Based on market timing theory, the authors find that corporate investment occurs in periods of high valuation motivated by equity issuance to benefit from the low cost of capital. This effect is more prominent for financially constrained firms. Consistent with the catering channel, the authors find that the misvaluation-investment nexus is more pronounced in firms with short-horizon investors. By examining the stocks’ long-term performance of misvalued firms, via a sorting portfolio procedure, the authors find that undervalued firms outperform and generate higher abnormal returns (Jensen’s alpha) than overvalued firms, suggesting that mispricing-driven investment appear to be short-lived and lead to lower return in the long term.Practical implicationsCorporate decision-makers and governance structures should pay attention to the rationality of the corporate investment decision in the context of equity market misvaluation. Managers who focus on maximizing the stock market value in the short-run at the expense of its long-term performance must give preference to value-creating investment, not driven by an external mechanism such as equity market mispricing. More generally, investors and portfolio managers must take into account the market mispricing process in decision-making. Nonetheless, from the portfolio sorting perspective, decision-makers must act in terms of high governance quality to mitigate suboptimal investment due to stock market mispricing (Jensen, 2005). Finally, equity market overvaluation, leading managers to invest via equity financing in particular, should be a signal to attract investors’ attention to seize the window of opportunity and embark on a short-term portfolio strategy. Such a strategy promises high returns in the short term.Originality/valueThis paper investigates jointly two theoretical channels: equity market timing and catering. The authors propose for the analysis three components of the M/B decomposition to dissociate market misvaluation at the firm and industry level from the fundamental component of market value (growth). This procedure provides a better understanding of the role of firm and industry misvaluation in explaining corporate investments. The authors provide evidence of the equity market misvaluation via a portfolio sorting procedure and a Carhart (1997) four-factor pricing model. The authors examine the effect of misvaluation on both the investment and the financing decisions.

L’ouvrage de A. Hagui se propose de fournir une réflexion organisée en trois temps. Il s’agit d’abord d’identifier un cadre théorique et conceptuel « pertinent » pour traiter la problématique de l’aménagement des territoires sensibles en Tunisie ; de développer ensuite un modèle « clinique » d’aménagement desdits territoires moyennant « une approche purement participative » qui s’inscrive dans la durabilité ; et, enfin, de tester de façon empirique la « thérapie » proposée en prenant comme c...