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016) and clinico-radiological remission (p=0.028).

An Anti-TNFα based treatment combined with long term loose seton drainage have contributed to the high rates of both clinical and radiological responses in this study. Obtaining a "deep" clinico-radiological remission should be the target of the treatment. Stopping the Anti-TNFα should be avoided even after obtaining such response.

An Anti-TNFα based treatment combined with long term loose seton drainage have contributed to the high rates of both clinical and radiological responses in this study. Obtaining a "deep" clinico-radiological remission should be the target of the treatment. Stopping the Anti-TNFα should be avoided even after obtaining such response.Urothelial bladder carcinoma (UBC) includes a large group of malignancies with a variable clinical behavior. Despite remarkable developments in recognition of bladder carcinogenesis and prognostic factors, the recurrence rate is still high. Thus, identification of novel biomarkers involved in tumor cell invasion and metastatic dissemination is a constant challenge.

To assess the prognostic impact of CD44 standard (CD44s) expression in UBT.

We assessed the immunohistochemical expression of CD44 in 38 samples of endoscopically resected UBT. Only membranous staining was considered positive. We analyzed topographic distribution of CD44s staining. Correlation of CD44s expression, clinicopathological features and disease progression was analyzed by Chi2 and Fisher tests. Kaplan-Meier analysis was used to investigate CD44s prognostic value.

The mean age of patients was 61,24 years with male to female ratio of 18/1. CD44s expression was positive in 33 cases (87%). There was no significant correlation between CD44 expression and the parameters age, gender, tumor size, focality, tumor site, stage, recurrence and tumor progression. CD44s loss of expression is, nevertheless, correlated with a high tumor grade. Topographic distribution of CD44s staining was associated with focality, grade and stage. Basal/parabasal staining expanded to the tumor layers in homogeneous "laminate" pattern used to be of better prognosis, compared to the heterogeneous "islets" or "dispersed" pattern.

Our results highlighted the prognostic value of CD44 expression in UBT. Focusing especially on staining pattern offers a better understanding of bladder carcinogenesis mechanisms.

Our results highlighted the prognostic value of CD44 expression in UBT. Focusing especially on staining pattern offers a better understanding of bladder carcinogenesis mechanisms.Routine respiratory functional explorations (RFEs) performed as a part of the exploration of the respiratory deficiency include spirometry, plethysmography, bronchodilation test, measurement of the carbon monoxide diffusion capacity (DLCO), non-specific bronchial challenge (NSBC) and the measurement of the exhaled fraction of nitric oxide (FeNO). Functional exploration of disability is most often achieved by the 6-minute walk test (6MWT). All these RFEs were the subject of European and/or American consensus conferences in 2005 for the spirometry and plethysmography, in 2014 for the 6MWT, in 2015 for the FeNO, in 2017 for the NSBC and for the DLCO. The interpretation of the RFEs must therefore rationally be carried out according to the most recent international recommendations and requires reference to the lower and sometimes upper limits of normal (for spirometry, plethysmography, DLCO and 6-min walk distance), z-scores (for spirometry) or to fixed threshold values (for the bronchodilation test, FeNO and delivered dose of methacholine causing a 20% fall in forced expiratory volume in one second). Therefore, the main objective of this update was to expose the definitions and classifications of the various 'abnormalities' noted during the RFEs requested in the context of the exploration of the deficiency and incapacity of adult patients. This update will assist clinicians, especially pulmonologists, in the interpretation of the most commonly requested RFEs in practice.

The electrocardiogram (ECG) remains one of the most important and commonly used diagnostic tools in medicine. learn more At the faculty of Medicine of Tunis (FMT), teaching ECG interpretation to undergraduate medical students is an important part of the curriculum.

To assess the effectiveness of pedagogical workshops in ECG learning among students of First-year of the primary cycle of medical studies (PCMS 1). In addition, we aimed to assess the students' perceptions of the tutorials.

It was an exhaustive cross-sectional study that was carried out at the FMT during the academic year 2017-2018 and that included students from PCMS 1. All participants completed a pre-test, a workshop session and a post-test. Each of the tests consists of five Multiple Choice Questions (MCQs) covering the same topics. An evaluation of students' satisfaction with the tutorial was made at the end of the session.

Ten workshops were held at the FMT, including 160 students. The overall score increased from 4 out of 10 points in the pre-test to 6.8 out of 10 points in the post-test (p <0.001). A statistically significant improvement was noted in all tests questions (p<0.001). Sixty-one learners (39.3%) were "Not satisfied" with the number of students per group. On the whole, 83.8% (n=130) of students found the session beneficial.

Students indicated a positive attitude toward the workshop and its utility. link2 More research among similar populations is needed to support these conclusions and to assess the effectiveness of medium- and long-term educational workshops on medical students.

Students indicated a positive attitude toward the workshop and its utility. More research among similar populations is needed to support these conclusions and to assess the effectiveness of medium- and long-term educational workshops on medical students.

The quality of the training of medical students is one of the guarantors of the proper functioning of our health system. Gamification is an innovative educational pedagogical method that stimulates the pleasure of learning and encourages learner motivation.

To evaluate the subjective and external motivations and academic self-efficacy of DCEM1 students by playing with TD sessions designed to learn the systematic interpretation of rhythm disorders on surface ECGs using playing cards.

It was a descriptive, cross-sectional study. Three successive groups of 25 students each took part in this study which took place at the Faculty of Medicine of Tunis. link3 Each group was subdivided into 5 subgroups. During the TD session, the same 18 playing cards are distributed to each subgroup, and various wide and thin QRS tachycardia ECG plots are projected successively. Each subgroup should collect playing cards related to the methodical interpretation of each ECG trace and establish the final diagnosis of rhythm disorder. generalized throughout all ECG sessions.

Gamification learning seems to be an effective and appropriate approach to teaching in the medical field since it allows to associate the notion of pleasure and the act of learning and stimulating motivation and self-efficacy learners.

Gamification learning seems to be an effective and appropriate approach to teaching in the medical field since it allows to associate the notion of pleasure and the act of learning and stimulating motivation and self-efficacy learners.

Learning clinical teaching is an alternative to traditional forms of teaching. Its objective is to lead the student to acquire a relevant diagnostic approach by developing a clinical reasoning.

To evaluate these sessions in Pediatrics, with students in the second cycle of medical study.

A session on the topic of "stunting" was scheduled as a CRL with second cycle of medical studies 2 (SCMS2) students during their Pediatrics internship, with a pre and post-test administered and a self-administered questionnaire.

Two groups of students that included twenty-three students participated in the session. Pre-test scores ranged from 0/10 to 6.8 / 10 and post-test scores from 6.5 / 10 to 9/10. The average pre- and post-test scores, were respectively 4.26 ± 1.37/10 and 7.35 ± 0.7 / 10 (P <0.001). Twenty-two students reported their overall satisfaction with teaching. The overall rating score was 4.39 ± 0.49/ five points. The average of the ratings for new knowledge delivery, achievement of educational objectives, interaction and participation were greater than 4.3 / 5.

This form of small group learning seems to have legitimacy in Pediatric education.

This form of small group learning seems to have legitimacy in Pediatric education.

To assess the effectiveness of Hand Hygiene (HH) in preventing infections and the transmission of pathogens, in an epidemic context, in community and hospital settings.

It is a systematic review of the literature based on a document request, conducted on PubMed, using the following search equation "(" Hand Hygiene "[All Fields] OR" Hand Disinfection "[All Fields]) AND ("Epidemics" [All Fields] OR "Pandemics" [All Fields]) ". All publications related to the effectiveness of the preventive intervention for HH in an epidemic setting were Included.

A total of 16 publications were included, of which the majority proved the effectiveness of HH and its promotion in reducing infections during an epidemic. In a clinical trial, promoting HH in an intervention group significantly reduced the prevalence of infections (24.4% vs. 11.1%). Two systematic reviews have shown the effectiveness of HH in preventing the transmission of germs with ORs between 0.52 and 0.62. Four case-control studies and three cross-sectional studies concluded with the protective effect of HH with ORs varying between 0.06 and 0.71. A cohort study showed that low adherence to HH recommendations was associated with a higher infection rate (77.5% vs 95%; p = 0.02). A single systematic review did not conclude that HH was effective in the epidemic setting.

The effectiveness of HH in the fight against epidemics has been demonstrated. It is dependent on the engagement and the active participation of the different intervenient. Hence the need to increase accessibility to different methods of HH and to promote the importance of this prevention strategy could be assured through education and awareness.

The effectiveness of HH in the fight against epidemics has been demonstrated. It is dependent on the engagement and the active participation of the different intervenient. Hence the need to increase accessibility to different methods of HH and to promote the importance of this prevention strategy could be assured through education and awareness.

Sarcomatoid transformation in chromophobe renal cell carcinoma is extremely rare.Gastrointestinal symptoms in renal cell carcinoma are rare and are often secondary to the tumor local growth. While these symptoms are essentially represented by gastrointestinal bleeding, symptoms related to colonic perforation are extremely rare. Only four cases have been described having such a direct invasion which was revealed by gastrointestinal bleeding and that all of them were clear cell- RCC type. No case of chromophobe renal cell carcinoma with direct colonic invasion witch was revealed by colic occlusion, perforation and secondary peritonitis has been found in the literature. Our case report provides more evidence that chromophobe renal cell carcinoma has a propensity to progress to a high-grade spindle cell malignancy with sarcomatoid features gaining an ability to invade other organs such as colon in our case.

We report a case of a pT4 stage renal cell carcinoma, chromophobe type of solid growth with high nuclear grade (Fuhrman grade 4), extensive sarcomatoid differentiation (60 %), and multifocal tumor necrosis.