Search results for: southeastern tunisia

Authors: Omar Nouri, Wafa Mnejja, Fatma Dhouib, Syrine Zouari, Wicem Siala, Ilhem Charfeddine, Afef Khanfir, Leila Farhat, Nejla Fourati, Jamel Daoud

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Purpose and Objective: Intensity modulated radiation (IMRT) technique, associated with induction chemotherapy (IC) and/or concomitant chemotherapy (CC), is actually the recommended treatment modality for nasopharyngeal carcinomas (NPC). The aim of this study was to evaluate the therapeutic results and the patterns of relapse with this treatment protocol. Material and methods: A retrospective monocentric study of 145 patients with NPC treated between June 2016 and July 2021. All patients received IMRT with integrated simultaneous boost (SIB) of 33 daily fractions at a dose of 69.96 Gy for high-risk volume, 60 Gy for intermediate risk volume and 54 Gy for low-risk volume. The high-risk volume dose was 66.5 Gy in children. Survival analysis was performed according to the Kaplan-Meier method, and the Log-rank test was used to compare factors that may influence survival. Results: Median age was 48 years (11-80) with a sex ratio of 2.9. One hundred-twenty tumors (82.7%) were classified as stages III-IV according to the 2017 UICC TNM classification. Ten patients (6.9%) were metastatic at diagnosis. One hundred-thirty-five patient (93.1%) received IC, 104 of which (77%) were TPF-based (taxanes, cisplatin and 5 fluoro-uracil). One hundred-thirty-eight patient (95.2%) received CC, mostly cisplatin in 134 cases (97%). After a median follow-up of 50 months [22-82], 46 patients (31.7%) had a relapse: 12 (8.2%) experienced local and/or regional relapse after a median of 18 months [6-43], 29 (20%) experienced distant relapse after a median of 9 months [2-24] and 5 patients (3.4%) had both. Thirty-five patients (24.1%) died, including 5 (3.4%) from a cause other than their cancer. Three-year overall survival (OS), cancer specific survival, disease free survival, metastasis free survival and loco-regional free survival were respectively 78.1%, 81.3%, 67.8%, 74.5% and 88.1%. Anatomo-clinic factors predicting OS were age > 50 years (88.7 vs. 70.5%; p=0.004), diabetes history (81.2 vs. 66.7%; p=0.027), UICC N classification (100 vs. 95 vs. 77.5 vs. 68.8% respectively for N0, N1, N2 and N3; p=0.008), the practice of a lymph node biopsy (84.2 vs. 57%; p=0.05), and UICC TNM stages III-IV (93.8 vs. 73.6% respectively for stage I-II vs. III-IV; p=0.044). Therapeutic factors predicting OS were a number of CC courses (less than 4 courses: 65.8 vs. 86%; p=0.03, less than 5 courses: 71.5 vs. 89%; p=0.041), a weight loss > 10% during treatment (84.1 vs. 60.9%; p=0.021) and a total cumulative cisplatin dose, including IC and CC, < 380 mg/m² (64.4 vs. 87.6%; p=0.003). Radiotherapy delay and total duration did not significantly affect OS. No grade 3-4 late side effects were noted in the evaluable 127 patients (87.6%). The most common toxicity was dry mouth which was grade 2 in 47 cases (37%) and grade 1 in 55 cases (43.3%).Conclusion: IMRT for nasopharyngeal carcinoma granted a high loco-regional control rate for patients during the last five years. However, distant relapses remain frequent and conditionate the prognosis. We identified many anatomo-clinic and therapeutic prognosis factors. Therefore, high-risk patients require a more aggressive therapeutic approach, such as radiotherapy dose escalation or adding adjuvant chemotherapy.

Keywords: therapeutic results, prognostic factors, intensity-modulated radiotherapy, nasopharyngeal carcinoma

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Authors: Abdelkader Soumaya, Aymen Arfaoui, Noureddine Ben Ayed, Ali Kadri

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The Chotts belt represents the southernmost folded structure in the Tunisian Atlas domain. It is dominated by inherited deep extensional E-W trending fault zones, which are reactivated as strike-slip faults during the Cenozoic compression. By examining the geological maps at different scales and based on the fieldwork data, we propose new structural interpretations for the geometries and fault kinematics in the Chotts chain. A set of ENE-WSW right-lateral en echelon folds, with curved shapes and steeply inclined southern limbs, is visible in the map view of this belt. These asymmetric tight anticlines are affected by E-W trending fault segments linked by local bends and stepovers. The revealed kinematic indicators along one of these E-W striated faults (Tafferna segment), such as breccias and gently inclined slickenlines (N094, 80N, 15°W pitch angles), show direct evidence of dextral strike-slip movement. The calculated stress tensors from corresponding faults slip data reveal an overall strike-slip tectonic regime with reverse component and NW-trending sub-horizontal σ1 axis ranking between N130 to N150. From west to east, we distinguished several types of structures along the segmented dextral fault system of the Chotts Range. The NE-SW striking fold-thrust belt (~25 km-long) between two continuously linked E-W fault segments (NW of Tozeur town) has been suggested as a local restraining bend. The central part of the Chotts chain is occupied by the ENE-striking Ksar Asker anticlines (Taferna, Torrich, and Sif Laham), which are truncated by a set of E-W strike-slip fault segments. Further east, the fault segments of Hachichina and Sif Laham connected across the NW-verging asymmetric fold-thrust system of Bir Oum Ali, which can be interpreted as a left-stepping contractional bend (~20 km-long). The oriental part of the Chotts belt corresponds to an array of subparallel E-W oriented fault segments (i.e., Beidha, Bouloufa, El Haidoudi-Zemlet El Beidha) with similar lengths (around 10 km). Each of these individual separated segments is associated with curved ENE-trending en echelon right-stepping anticlines. These folds are affected by a set of conjugate R and R′ shear-type faults indicating a dextral strike-lip motion. In addition, the relay zones between these E-W overstepping fault segments define local releasing stepovers dominated by NW-SE subsidiary faults. Finally, the Chotts chain provides well-exposed examples of strike-slip tectonics along E-W distributed fault segments. Each fault zone shows a typical strike-slip architecture, including parallel fault segments connecting via local stepovers or bends. Our new structural interpretations for this region reveal a great influence of the E-W deep fault segments on regional tectonic deformations and stress field during the Cenozoic shortening.

Keywords: chotts belt, tunisian atlas, strike-slip fault, stepovers, fault segments

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Authors: Abidi Sourour, Ben Salem Hichem, Zoghlemi Aziza, Mezni Mejid, Nasri Saida

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In Tunisia, there is an urgent need to maintain food security by reversing soil degradation and improving crop and livestock productivity. Conservation Agriculture (CA) can be helpful in enhancing crop productivity and soil health. However, the demand for crop residues as animal feed are among the major constraints for the adoption of CA. Thus, the objective of this trial is to test the nutritional value of new forage mixture hays as alternative to cereal residues. Two tri-specific cereal-legume mixture were studied and compared to the classic Vetch-Oat one. They were implemented at farm level in four regions characterized by sub-humi climatic: V70-A15-T15 (Vetch70% - Oat15% -Triticale15%) installed in two sites (Zhir and safasaf), V60-A7-T33 (Vetch60% - Oat7% -Triticale33%) and V70-A30 (Vetch70%-Oat30%). Results revealed a significant variation between mixtures V70-A15-T15 installed at Safsafa, recorded the highest forage yield with 12t DM ha-1 than V60A7T33 and V70A30 installed, respectively in ksar cheikh and Fernana with 11.6 and 11.2.tMSha-1. The same mixture installed in Safsafa gave 22% less yields than the one installed in Safsafa. In fact, the month of March was dry in Z'hir. Moreover, these yields in DM can be comparable to those observed by Yucel and Avci (2009). The CP contents of the samples studied vary significantly between the mixtures (P<0.0003). V70-A15-T15 installed in Safsaf and V70A30 present higher contents of CP (respectively 14.4 and 13.7% DM) compared to the other mixtures. These contents are explained by the high proportion of vetch in the fourth mixture and by the low proportion of weeds in the second. In all cases, the hay produced from these mixtures is significantly richer in protein than that of oats in pure culture (Abdelraheem et al., 2019). The positive correlation between the CP content and the proportion of vetch explains this superior quality. The NDF and ADF contents were similar for all mixtures. These values were similar to those reported in the literature (Abidi and Benyoussef, 2019; Haj-Ayed and al., 2000). In general, the Land Equivalent Ratio (LER) was significantly greater than 1 for the vetch-oat-triticale mixture at Zhiir and Safsafa and also for the vetch-oat a at Fernana, proving that they are more productive in intercropping than in pure culture. For the Ksar Cheikh site, the LER value of the vetch-oat-triticale mixture is maintained at around 1. Proving the absence of the advantage of mixture culture compared to pure culture. This proves the massive presence of weeds interferes with the two partners of the mixture increases. The LER for the vetch-oat mixture reached its maximum in March 13 and decreases in April but remained above 1. This proves that the tutoring power of oats showed itself in a constant way until an advanced stage since the variety used is characterized by very thick stems, protecting it from the risk of lodging. These forages mixture present a promising option, a high nutritional quality that could reduce the use of concentrate and, therefore, the cost of feed. With such feed value, these mixtures allow good animal performance.

Keywords: soybean, lupine, vetch, lamb-ADG, meat

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Authors: Ezzi Olfa, Bouafia Nabiha, Ammar Asma, Ben Cheikh Asma, Mahjoub Mohamed, Bannour Wadiaa, Achour Bechir, Khelif Abderrahim, Njah Mansour

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Background: In hematology/oncology, health care improvement has allowed increasingly aggressive management in diagnostic and therapeutic procedures. Nevertheless, these intensified procedures have been associated with higher risk of healthcare associated infections (HAIs). We undertook this study to estimate the burden of HAIs in the cancer patients in an onco -hematology unit in a Tunisian university hospital. Materials/Methods: A prospective, observational study, based on active surveillance for a period of 06 months from Mars through September 2016, was undertaken in the department of onco-hematology in a university hospital in Tunisia. Patients, who stayed in the unit for ≥ 48 h, were followed until hospital discharge. The Centers for Disease Control and Prevention criteria (CDC) for site-specific infections were used as standard definitions for HAIs. Results: One hundred fifty patients were included in the study. The gender distribution was 33.3% for girls and 66.6% boys. They have a mean age of 23.12 years (SD = 18.36 years). The main patient’s diagnosis is: Acute Lymphoblastic Leukemia (ALL): 48.7 %( n=73). The mean length of stay was 21 days +/- 18 days. Almost 8% of patients had an implantable port (n= 12), 34.9 % (n=52) had a lumber puncture and 42.7 % (n= 64) had a medullary puncture. Chemotherapy was instituted in 88% of patients (n=132). Eighty (53.3%) patients had neutropenia at admission. The incidence rate of HAIs was 32.66 % per patient; the incidence density was 15.73 per 1000 patient-days in the unit. Mortality rate was 9.3% (n= 14), and 50% of cases of death were caused by HAIs. The most frequent episodes of infection were: infection of skin and superficial mucosa (5.3%), pulmonary aspergillosis (4.6%), Healthcare associated pneumonia (HAP) (4%), Central venous catheter associated infection (4%), digestive infection (5%), and primary bloodstream infection (2.6%). Finally, fever of unknown origin (FUO) incidence rate was 14%. In case of skin and superficial infection (n= 8), 4 episodes were documented, and organisms implicated were Escherichia.coli, Geotricum capitatum and Proteus mirabilis. For pulmonary aspergillosis, 6 cases were diagnosed clinically and radiologically, and one was proved by positive aspergillus antigen in bronchial aspiration. Only one patient died due this infection. In HAP (6 cases), four episodes were diagnosed clinically and radiologically. No bacterial etiology was established in these cases. Two patients died due to HAP. For primary bloodstream infection (4 cases), implicated germs were Enterobacter cloacae, Geotricum capitatum, klebsiella pneumoniae, and Streptococcus pneumoniae. Conclusion: This type of prospective study is an indispensable tool for internal quality control. It is necessary to evaluate preventive measures and design control guides and strategies aimed to reduce the HAI’s rate and the morbidity and mortality associated with infection in a hematology/oncology unit.

Keywords: cohort prospective studies, healthcare associated infections, hematology oncology department, incidence

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Authors: Fatih Ercin Guney, Hami Karagol

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Day by day, humanity's energy needs increase, to facilitate access to energy sources by energy importing countries is of great importance in terms of issues both in terms of economic security and political security. The geographical location of the oil exporting countries in the Middle East (Iran, Iraq, Kuwait, Libya, Saudi Arabia, United Arab Emirates, Qatar) today, it is observed that evaluated by emerging Arab Spring(from Tunisia to Egypt) and freedom battles(in Syria) with security issues arise sourced from terrorist activities(ISIS). Progresses related with limited natural resources, energy and it's transportation issues which worries the developing countries, the energy in the region is considered to how to transfer safely. North Region of the Black Sea , the beginning of the conflict in the regional nature formed between Russia and Ukraine (2010), followed by the relevant regions of the power transmission line (From Russia to Europe) the discovery is considered to be the east's hand began to strengthen in terms of both the economical and political sides. With the growing need for safe access to the west of the new energy transmission lines are followed by Turkey, re-interest is considered to be shifted to the Mediterranean and the Middle East by West. Also, Russia, Iran and China (three axis of east) are generally performing as carry out parallel policies about energy , economical side and security in both United Nations Security Council (Two of Five Permanent Members are Russia and China) and Shanghai Cooperation Organization. In addition, Eastern Mediterranean Region Tension are rapidly increasing about research new oil and natural gas sources by Israel, Egypt, Cyprus, Lebanon. This paper provides, new energy corridor(s) are needed to transfer sources (Oil&Natural Gas) by Europe from East to West. So The West needs either safe bridge country to transfer natural sources to Europe in region or is needed to discovery new natural sources in extraterritorial waters of Eastern Mediterranean Region. But in two opportunities are evaluated with secure transfer corridors form region to Europe in safely. Even if the natural sources can be discovered, they are considered to transfer in safe manner. This paper involved, Turkey’s importance as a leader country in region over both of political and safe energy transfer sides as bridge country between south and north of Turkey why natural sources shall be transferred over Turkey, Even if diplomatic issues-For Example; Cyprus membership in European Union, Turkey membership candidate duration, Israel-Cyprus- Egypt-Lebanon researches about new natural sources in Mediterranean - occurred. But politic balance in Middle-East is changing quickly because of lack of democratic governments in region. So it is evaluated that the alliance of natural sources researches may not be long-time relations due to share sources after discoveries. After evaluating over causes and reasons, aim to reach finding foresight about future of region for energy transfer periods in secure manner.

Keywords: Middle East, natural gas, oil, Turkey

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Authors: Sanaa Riaz

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The free people, Amazigh (plural Imazighen), often known by the more popular exonym, Berber, are spread across several North African countries with the highest population in Morocco have been substantially misunderstood and differentially showcased by entities from western-school educated scholars to human, health and women’s rights organizations, to the State to the international community. This paper is an examination of the various conceptualization of the Imazighen. With the popularity of the Arab Spring movement to oust monarchical and dictatorial rulers across the Middle East and North Africa in Morocco, the Moroccan monarchy introduced various reform programs to win public favor. These included social, economic and educational reforms to incorporate marginalized groups such as the Imazighen. The monarchy has ushered Amazigh representation in public offices and landscape through Amazigh script, even though theirs has been an oral culture. After the Arab Spring, the Justice and Development party, an Islamist party took over in Morocco due to its accessibility to the masses, In Sept. 2021, unlike the case of Egypt and Tunisia where military and constitutional means were sought, Morocco successfully removed it from power through the ballot, resulting in a real victory for the neutral monarchy and its representation as a moderate, secular and liberal force for the nation. As a result, supporting the perpetuation of Amazigh linguistic identity also became synonymous to making a secular statement as a Muslim. It has led to the telling of Amazigh identity at state museums as one representing the indigenous, pure, diverse, culturally-rich and united Morocco. Reform efforts have also prioritized an amiable look towards the economic and familial links of Moroccan Jews with the few thousand families still left in the country and a showcasing through museums and cultural centers of the Jewish identity as Moroccan first. In that endeavor, it is interesting to note the coverage of Jews as the indigenous of Morocco through the embracing of their “folk” cultural and religious practices, those that are not continued outside Morocco. In this epistemology, the concept of the Moroccan Jew becomes similar to the indigenous Amazigh, both cherished as the oldest peoples of Morocco and symbols of its unity and resilience. In the urban discourse, Amazigh identity is a concept that continues to be part of the deliberations of elites and scholars graduating from French schools on the incorporation of rural and illiterate Morocco in economic and educational advancement. Yet, with the constant influx of migrants from Western Sahara into cities like Fez and Marrakesh, Amazigh has often been described as the umbrella term of those of “mixed” ethnic ancestry who constitute the country’s free population. In sum, Amazigh identity highlights the changing discourse on marginalized communities, human rights, representation, Moroccan nationhood, and regional and transnational politics. The aim of this paper is to analyze perceptions of Amazigh identity in Morocco post-2021 ousting of the Islamist party using data from state-sponsored museum displays and cultural centers collected in Summer 2022 and scholarly analyses of Amazigh identity, representation and rights in Morocco.

Keywords: Amazigh identity, Morocco, representation, state politics

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Authors: Negar Vkilbashi, Hassan Kabiri

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Modern diplomacy, in its general form, refers to the people and not the governments, and diplomacy tactics are more addressed to the people than to the governments. Media diplomacy and cyber diplomacy are also one of the sub-branches of public diplomacy and, in fact, the role of media in the process of influencing public opinion and directing foreign policy. Mass media, including written, radio and television, theater, satellite, internet, and news agencies, transmit information and demands. What the Qatari government tried to implement in the countries of the region during the Arab Spring and after was through its important media, Al Jazeera. The embargo on Qatar began in 2017, when Saudi Arabia, the United Arab Emirates, Bahrain, and Egypt imposed a land, sea, and air blockade against the country. The media tool constitutes the cornerstone of soft power in the field of foreign policy, which Qatari leaders have consistently resorted to over the past two decades. Undoubtedly, the role it played in covering the events of the Arab Spring has created geopolitical tensions. The United Arab Emirates and other neighboring countries sometimes criticize Al Jazeera for providing a platform for the Muslim Brotherhood, Hamas, and other Islamists to promote their ideology. In 2011, at the same time as the Arab Spring, Al Jazeera reached the peak of its popularity. Al Jazeera's live coverage of protests in Tunisia, Egypt, Yemen, Libya, and Syria helped create a unified narrative of the Arab Spring, with audiences tuning in every Friday to watch simultaneous protests across the Middle East. Al Jazeera operates in three groups: First, it is a powerful base in the hands of the government so that it can direct and influence Arab public opinion. Therefore, this network has been able to benefit from the unlimited financial support of the Qatar government to promote its desired policies and culture. Second, it has provided an attractive platform for politicians and scientific and intellectual elites, thus attracting their support and defense from the government and its rulers. Third, during the last years of Prince Hamad's reign, the Al Jazeera network formed a deterrent weapon to counter the media and political struggle campaigns. The importance of the research is that this network covers a wide range of people in the Middle East and, therefore, has a high influence on the decision-making of countries. On the other hand, Al Jazeera is influential as a tool of public diplomacy and soft power in Qatar's foreign policy, and by studying it, the results of its effectiveness in the past years can be examined. Using a qualitative method, this research analyzes the impact of the media on the implementation of Qatar's foreign policy on the public opinion of the people of the Middle East. Data collection has been done by the secondary method, that is, reading related books, magazine articles, newspaper reports and articles, and analytical reports of think tanks. The most important findings of the research are that Al Jazeera plays an important role in Qatar's foreign policy in Qatar's public diplomacy. So that, in 2011, 2017 and 2023, it played an important role in Qatar's foreign policy in various crises. Also, the people of Arab countries use Al-Jazeera as their first reference.

Keywords: Al Jazeera, Qatar, media, diplomacy

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Authors: Lamia Bouzgarrou, Irtyah Merchaoui, Amira Omrane, Salma Kammoun, Amine Daafa, Neila Chaari

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Backgrounds: Currently, low back pain (LBP) is one of the most prevalent public health problems, which caused severe morbidity among a large portion of the adult population. It is also associated with heavy direct and indirect costs, in particular, related to absenteeism and early retirement. Health care workers are one of most occupational groups concerned by LBP, especially because of biomechanical and psycho-organizational risk factors. Our current study aims to investigate risk factors associated with chronic low back pain among Tunisian caregivers in university-hospitals. Methods: Cross-sectional study conducted over a period of 14 months, with a representative sample of caregivers, matched according to age, sex and work department, in two university-hospitals in Tunisia. Data collection included items related to socio-professional characteristics, the evaluation of the working capacity index (WAI), the occupational stress (Karazek job strain questionnaire); the quality of life (SF12), the musculoskeletal disorders Nordic questionnaire, and the examination of the spine flexibility (distance finger-ground, sit-stand maneuver and equilibrium test). Results: Totally, 293 caregivers were included with a mean age equal to 42.64 ± 11.65 years. A body mass index (BMI) exceeding 30, was noted in 20.82% of cases. Moreover, no regular physical activity was practiced in 51.9% of cases. In contrast, domestic activity equal or exceeding 20 hours per week, was reported by 38.22%. Job strain was noted in 19.79 % of cases and the work capacity was 'low' to 'average' among 27.64% of subjects. During the 12 months previous to the investigation, 65% of caregivers complained of LBP, with pain rated as 'severe' or 'extremely severe' in 54.4% of cases and with a frequency of discomfort exceeding one episode per week in 58.52% of cases. During physical examination, the mean distance finger-ground was 7.10 ± 7.5cm. Caregivers assigned to 'high workload' services had the highest prevalence of LBP (77.4%) compared to other categories of hospital services, with no statistically significant relationship (P = 0.125). LBP prevalence was statistically correlated with female gender (p = 0.01) and impaired work capacity (p < 10⁻³). Moreover, the increase of the distance finger-ground was statistically associated with LBP (p = 0.05), advanced age (p < 10⁻³), professional seniority (p < 10⁻³) and the BMI ≥ 25 (p = 0.001). Furthermore, others physical tests of spine flexibility were underperformed among LBP suffering workers with a statistically significant difference (sit-stand maneuver (p = 0.03); equilibrium test (p = 0.01)). According to the multivariate analysis, only the domestic activity exceeding 20H/week, the degraded quality of physical life, and the presence of neck pain were significantly corelated to LBP. The final model explains 36.7% of the variability of this complaint. Conclusion: Our results highlighted the elevate prevalence of LBP among caregivers in Tunisian public hospital and identified both professional and individual predisposing factors. The preliminary analysis supports the necessity of a multidimensional approach to prevent this critical occupational and public health problem. The preventive strategy should be based both on the improvement of working conditions, and also on lifestyle modifications, and reinforcement of healthy behaviors in these active populations.

Keywords: health care workers, low back pain, prevention, risk factor

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