Manouba University

Abstract Introduction: Vascular injury during total hip arthroplasty (THA) is a rare but life-threatening complication. Severe anatomical distortion, particularly in complex hip pathology, may substantially increase this risk. Case presentation: A 62-year-old woman with a history of childhood septic arthritis presented with a chronically dislocated hip and advanced joint destruction. During THA, sudden massive hemorrhage occurred during acetabular exposure. Postoperative absence of distal pulses and a sensorimotor deficit raised suspicion of acute limb ischemia. CT angiography confirmed femoral artery occlusion. Emergency vascular exploration revealed complete transection of the common and superficial femoral arteries, which were reconstructed using a PTFE graft. Clinical discussion: Neglected septic hip dislocation profoundly alters local anatomy, bringing major vessels into close proximity to the acetabulum and increasing the risk of vascular injury. Early recognition of abnormal bleeding and postoperative vascular compromise is essential. Close collaboration between orthopedic, anesthesiology and vascular teams is critical to achieving limb salvage and preventing fatal outcomes. Selective use of CT angiography can aid preoperative risk assessment in hips with severe anatomical distortions. Conclusion: Vascular injury during THA is a rare but serious complication. Meticulous surgical technique, systematic postoperative vascular examination, and prompt multidisciplinary intervention are critical to optimize survival and limb salvage.

Malnutrition and sarcopenia are highly prevalent in intensive care settings and are associated with adverse clinical outcomes. The study aimed to evaluate the association between nutritional care, nutritional status, and patient outcomes in intensive care units. This prospective observational study at a Tunisian tertiary hospital investigated nutritional status and management of 100 intensive care unit patients, each of whom was followed for seven days after ICU admission. Malnutrition Risk was assessed by NUTRIC and MNA scores. The severity of disease was assessed using the APACHE II and SOFA scores. Malnutrition was diagnosed using body mass index and weight loss. Sarcopenia was assessed through grip strength, calf circumference, and psoas muscle area. Nutritional management was evaluated using calculations of caloric and protein intake. Clinical outcomes included the need for intubation, difficulty with oxygen weaning, healthcare-associated infections, and the development of pressure ulcers. The participants had a mean age of 54.85 ± 17.25 years, with a slight male predominance (53 males, 47 females). Pre-existing metabolic conditions affected 80% of patients, including hypertension (40 patients), diabetes (36), and obesity (18). The primary reasons for admission were respiratory disorders (25%), infectious diseases (23%), and metabolic disorders (16%). The mean APACHE II score was 15.91 ± 6.84, and the mean NUTRIC score was 3 ± 1.66; 27% were classified as at high risk of malnutrition. The prevalence of malnutrition reached 50% (28% moderate, 22% severe). Only 31% received adequate caloric intake, while 84% had insufficient protein intake. Malnourished patients required intubation more frequently (50% versus 22.5%; p = 0.014), experienced greater difficulty with oxygen weaning (78.4% versus 48.6%; p = 0.008), and developed pressure ulcers more often (43.5% versus 6%; p < 0.001). Sarcopenic patients showed similar patterns for intubation (51.4% versus 18.9%, p = 0.003), oxygen weaning difficulty (77.5% versus 46.9%, p = 0.007), and pressure ulcers (39.2% versus 6.7%, p < 0.001). Malnutrition and sarcopenia are highly prevalent in intensive care patients and are associated with severe complications, including prolonged mechanical ventilation and pressure ulcer development. Inadequate nutritional support remains common despite known consequences. Early comprehensive nutritional assessment and appropriate management from admission are essential to improve outcomes in critically ill patients.

Objectives This study compared the effectiveness of traditionally-planned (TPT) and randomly-planned (RPT) jump training regimens on physical performance metrics in youth academy soccer players. The groups undertook jump training with identical total programme volume and intensity, differing only in the order in which the prescribed training weeks were executed. Design A total of 28 male youth academy soccer players (mean age: 12.6 ± 0.26 yrs; height: 158.1 ± 7.24 cm; mass: 43.3 ± 5.1 kg; maturity offset: 0.81 ± 0.38 yrs; soccer experience: 4–5 years) were randomly assigned to either TPT or RPT groups, undertaking an eight-week training programme. Methods While the TPT group executed a planned training programme, the RPT group undertook identical training weeks performed in a randomised order with all other training variables being the same between the groups. Results Results indicated significant within-group improvements across all metrics (sprint speed [10 m, 20 m, 30 m], countermovement jump [CMJ], drop jump, and change of direction speed; [dz = 0.37 to 1.15; p = &lt;0.001]) except for the change-of-direction (CoD) test with no ball. No significant between-group differences were found except for in the CMJ, where the TPT group outperformed RPT (dz = 1.15 vs. 0.45, p &lt; 0.001). Conclusion These findings suggest that RPT regimens may yield similar performance outcomes to TPT programmes when matched for jump volume and intensity, though there may be a specificity advantage to using planned schemes. Using more flexible approaches might prove beneficial over time as it appears to encourage greater variability and could benefit coaches who are negatively affected by scheduling difficulties or other time constraints to a programme. This pilot investigation can help coaches and future researchers by serving as a basis for further study of flexible planning in youth populations and can provide preliminary guidance on how coaches can establish effective training programmes without necessarily having to adhere to rigid frameworks.

Strength training is fundamental during long-term athlete development to enhance strength and power supporting sport-specific performance. In rowing, trunk muscles stabilize the body and transmit forces between the lower and upper limbs. This study compared the effects of pre-season global (GST) versus local (LST) trunk strength training on muscle strength, power, and rowing-specific performance in young male rowers. Twenty-eight Tier 2 athletes aged 12-13 years (circa-PHV = 0.2-0.3) completed a 6-week program with two weekly sessions. GST involved machine-based and free-weight trunk exercises at 70% 1-RM, whereas LST emphasized body-weight trunk exercises on stable and unstable surfaces. Pre- and post-tests included lower- and upper-limb power, trunk strength, and a 700-m rowing ergometer test. Significant group-by-time interactions were found for all strength (d = 3.04-3.84; p < 0.001), power (d = 0.75-2.34; p < 0.01), and rowing performance outcomes (d = 1.61; p < 0.001). Post-hoc analyses indicated greater improvements in GST (d = 0.28-1.87; p < 0.001) than in LST (d = 0.11-0.73; p < 0.001). In conclusion, GST produced larger performance gains than LST. However, these effects likely reflect the combined influence of exercise modality and higher external loading intensity, rather than trunk muscle recruitment patterns alone. These findings should be interpreted with caution given that differences in external loading between conditions (70% 1-RM vs. athletes' body mass) confound the comparison of GST versus LST modalities. Strength and conditioning specialists may consider incorporating GST to enhance foundational strength and power in pubertal male rowers, but further research controlling for training load is needed to isolate the effects of exercise modality.

Background: Malnutrition in adolescents remains a significant public health issue worldwide, with undernutrition and overweight often coexisting. Accurate nutritional screening during adolescence is complicated by variability in biological maturation and class imbalance, particularly among underweight adolescents. Objective: This study aims to develop and validate machine learning models for classifying the nutritional status of adolescents, accounting for class imbalance and biological maturation, and to evaluate model stability and variable importance at different stages of peak height velocity (PHV). Methods: In this cross-sectional study, 4232 adolescents aged 11 to 18 years were recruited from nine educational institutions in Tunisia. Their nutritional status was classified according to the International Obesity Task Force (IOTF) BMI thresholds into three categories: underweight (14.4%), normal weight (68.3%), and overweight (17.2%). Ten anthropometric, behavioral, and maturation-related predictors were analyzed. Six supervised machine learning algorithms were evaluated using a 70/30 stratified split between training and test sets, with five-fold cross-validation. Class imbalance was addressed by ROSE combined with cost-sensitive learning. Model performance was assessed using accuracy, Cohen's kappa coefficient, macro F1 score, sensitivity, specificity, and AUC. Results: The cost-sensitive Random Forest (RF) model achieved the best overall performance, with an accuracy of 0.830, a macro F1 score of 0.767, a macro-AUC of 0.921, and a macro- sensitivity of 0.743. The class-specific sensitivities were 0.70 (underweight), 0.91 (normal weight), and 0.62 (overweight), with no major misclassification between the extreme categories. Performance remained stable across the different maturation phases (accuracy from 0.823 to 0.839), with optimal discrimination in the pre-PHV (macro-AUC = 0.936; sensitivity for underweight = 0.82) and post-PHV (macro-AUC = 0.931) periods. Body mass was the main predictor (importance = 1.00), followed by waist circumference (0.34-0.53). The importance of age for classifying underweight increased significantly from the pre-PHV (0.10) to the post-PHV (0.75) period. A two-stage hierarchical model further improved underweight detection (stage 1 AUC = 0.911; sensitivity = 0.732). Conclusions: A cost-sensitive RF model, combined with ROSE, provides robust classification of adolescents' nutritional status maturation, significantly improving underweight detection while preserving overall accuracy. This approach is particularly well-suited to public health screening in schools as a first-stage assessment that requires clinical confirmation and promotes a maturation-aware interpretation of nutritional risk among adolescents.