Biomedicine & Healthcare Research

Editorial

Thu, 31 Jul 2025 00:00:00 +0000

We are pleased to present this new issue of Biomedicine & Healthcare Research, the official scientific journal of the Faculty of Medicine of Sousse. This volume features a selection of literature reviews, original research articles, case series, and case reports that reflect the journal’s aims and scope.

This volume opens with a timely literature review by Aloulou et al., exploring the impact of gut microbiota dysbiosis on cancer-related cognitive impairment—a rapidly emerging field at the intersection of oncology, neurology, and microbiome science.

Among the original contributions, Chaieb et al. investigate the prevalence and determinants of imposter syndrome among nurses, shedding light on an often-overlooked psychological burden among healthcare professionals.

Meddeb et al. assess the impact of the COVID-19 pandemic on decision-making and diagnostic processes in non-COVID patients, offering valuable insights into systemic challenges during global health crises.

El Omri et al. contribute two original articles: the first provides clinical and therapeutic insights into laryngeal papillomatosis, while the second presents a 20-year single-center experience in managing pediatric acute mastoiditis, highlighting evolving practices in otolaryngology.

Other noteworthy contributions include:

Athimni et al. on occupational exposures to formaldehyde and wood dust in nasopharyngeal carcinoma,
A case series by Mseddi et al. on visceral artery aneurysms encountered in general surgery.
A rare case reported by El Hadhri et al. of concurrent gastrointestinal stromal tumor and small bowel adenocarcinoma in a patient with neurofibromatosis type 1

We thank all contributors and reviewers for their commitment to scientific rigor. This volume reflects our shared goal: to advance evidence-based medicine through meaningful, regionally grounded research.

We look forward to your continued readership and eagerly anticipate your future contributions to Biomedicine & Healthcare Research.

Concurrent gastrointestinal stromal tumor and small bowel adenocarcinoma in neurofibromatosis type 1: A rare case report

Thu, 31 Jul 2025 00:00:00 +0000

Introduction: Nasopharyngeal cancer is a distinctive entity compared to other head and neck cancers. In Tunisia, it is ranked as the second most common head and neck cancer after laryngeal cancer. Although its pathophysiology is unclear, several genetic and infectious predisposing factors have been identified. However, there is limited data available on environmental and occupational factors.

Material and method: This is a retrospective descriptive survey of the records of subjects with nasopharyngeal cancer. These subjects consulted the occupational medicine department of the Farhat Hached University Hospital, Sousse, over a 10-year period from 1 January 2010 to 31 December 2019.

Results: A total of four cases were recorded, illustrating a variety of occupational exposures. All patients were males. Cervical adenopathy was the first symptom to appear. The diagnosis was confirmed by biopsy. Pathological examination revealed 3 undifferentiated nasopharyngeal carcinoma (UCNT) and one well-differentiated non-keratinizing squamous cell carcinoma. Two patients were welders; one was a qualified dairy production operator and the fourth was a worker in a car company. Three patients were exposed to formaldehyde and one to wood dust with an average seniority of 11.25 years. All four cases had their cancer recognized as an occupational disease according to table 28 or 54.

Conclusion: All cases of nasopharyngeal cancer should be considered work-related, to ensure recognition as an occupational disease and to safeguard patients' rights to treatment and compensation.

Impact of gut microbiota dysbiosis on cancer-related cognitive impairment

Thu, 31 Jul 2025 00:00:00 +0000

Advances in cancer treatment have significantly improved survival rates among patients. However, many also experience cognitive changes as an adverse effect of both the disease and its therapies. This phenomenon is observed not only in patients with central nervous system (CNS) tumors but also in those with tumors located outside the CNS, and across all age groups.

Studies of patients with non-CNS malignancies have shown that cancer-related cognitive impairment (CRCI)—including deficits in memory, attention, executive function, and processing speed—affects up to 75% of patients during treatment and up to 30% prior to treatment. The gut–brain axis (GBA) is a complex, bidirectional communication system that has been identified as a potential link between neurodegeneration and alterations in the gut microbiota, influencing various brain functions. Gut microbes can produce a range of molecules, such as neurotransmitters, that enable neurochemical interactions with the host’s enteric, central, and autonomic nervous systems. While the specific changes may vary, cancer treatment-induced disruptions in the gut microbiota can compromise its protective and immunomodulatory roles, leading to increased production of harmful metabolites by pathogenic microbes. The role of the gut–brain axis and gut microbiota in CRCI remains largely unknown among many cancer care specialists. CRCI is often overlooked by healthcare professionals. The primary objective of this review is to highlight this underrecognized issue. Research into the cancer microbiota is an emerging field gaining importance in clinical oncology. Several studies have documented significant changes in gut microbial composition following cancer treatments, with reduced microbial diversity being the most reported alteration. This review synthesizes current clinical and preclinical evidence linking gut microbiota to CRCI, with a particular focus on future research directions—especially concerning disruptions in the gut–brain axis.

Imposter syndrome among nurses: Prevalence and associated factors

Thu, 31 Jul 2025 00:00:00 +0000

Introduction: Impostor syndrome (IS) can lead to substantial psychological distress among nurses, with potential repercussions for both their mental well-being and the quality of care they provide. This study aimed to assess the prevalence of impostor syndrome among nurses and to identify associated risk factors.

Methods: A cross-sectional study was conducted among all nurses (N = 612) working at Sahloul University Hospital in Tunisia between October 2023 and May 2024. The Clance Impostor Phenomenon Scale (CIPS), a validated 20-item instrument, was used to evaluate the presence and severity of IS. Multivariable logistic regression analysis was performed to determine factors associated with high impostor experiences, with a p-value of < 0.05 considered statistically significant.

Results: A total of 436 nurses participated in the study, yielding a response rate of 72.1%. The mean age of participants was 32.34 ± 10.01 years, and women constituted 61.0% of the sample. Additionally, 72.2% of respondents worked in medical departments. The mean CIPS score was 54.71 ± 12.36, indicating a moderate level of impostor syndrome. Notably, 27.1% of participants scored in the high IS range. Multivariable analysis identified two significant risk factors for high impostor experiences: being under 25 years of age (OR = 5.022; 95% CI: 2.160–11.680; p < 0.001) and working in a surgical department (OR = 2.920; 95% CI: 1.676–5.087; p < 0.001).

Conclusion: This study highlights the significant prevalence and impact of impostor syndrome among nurses. Early identification of at-risk individuals is crucial for implementing targeted interventions that reduce psychological distress and support both nurse well-being and the quality of patient care.

The impact of COVID-19 pandemic on decision and diagnostic making process in non-COVID-19 patients: A retrospective comparative study.

Thu, 31 Jul 2025 00:00:00 +0000

Introduction: The COVID-19 pandemic has been challenging and has affected non-COVID-19 patients to some extent. In this study, we aim to illustrate the impact of the COVID-19 pandemic on the decision and diagnostic making processes, management, and outcomes in non-COVID-19 patients.

Methods: A retrospective, comparative observational monocentric study with historical control, carried out in a 12-bed medical intensive care unit (ICU) between March 9, 2020, and May 30, 2020. All non-COVID-19 patients were included. Patients’ demographics, clinical characteristics, diagnoses before ICU, at admission, and diagnostic discrepancies, specific delays, management, and outcomes were collected. The impact on patients’ clinical state was assessed using a predefined grading scale describing the severity of diagnostic and management discrepancies. Patients included were compared to those admitted during the same period one year prior.

Results: During the two-month study period, 57 patients were referred to the ICU; 12(21%), COVID-19 and 45(79%) non-COVID-19 patients. Compared to the same period last year, the number of non-COVID-19 admissions was lower, 45 in 2020 vs 74 in 2019. Patients admitted during the pandemic received less noninvasive ventilation (NIV); 11(24.4%) vs 40(54.1%), p=0.009; and had shorter length of stay (LOS); 4[3-10.5] days vs 8[5-13] days, p=0.04. Diagnostic discrepancies were higher during the pandemic compared to last year; 16(35.5%) vs 5(6.8%), p=0.001. While this did not result in a significant impact on outcomes, in some cases, fear-induced cognitive bias may have altered decision-making and diagnostic processes. The sample size did not allow clear correlations; however, the study focused on assessing data on a case-by-case basis.

Conclusion: This study showed a high rate of diagnostic and management discrepancies in non-COVID-19 patients during the COVID-19 pandemic.

Occupational exposures to formaldehyde and wood dust in nasopharyngeal carcinoma: A 10-year case series from Tunisia

Thu, 31 Jul 2025 00:00:00 +0000

Results: A total of four cases were recorded, illustrating a variety of occupational exposures. All patients were males. Cervical adenopathy was the first symptom to appear. The diagnosis was confirmed by biopsy. Pathological examination revealed 3 undifferentiated nasopharyngeal carcinoma (UCNT) and one well-differentiated non-keratinizing squamous cell carcinoma. Two patients were welders, one was a qualified dairy production operator and the fourth was a worker in a car company. Three patients were exposed to formaldehyde and one to wood dust with an average seniority of 11.25 years. All four cases had their cancer recognized as an occupational disease according to table 28 or 54.

Conclusion: All cases of nasopharyngeal cancer should be considered to be of work-related origins, so that it can be recognized as an occupational disease and so that patients' rights to treatment and compensation can be preserved.

Insights into laryngeal papillomatosis: Diagnostic challenges, therapeutic advances, and evolutionary patterns

Thu, 31 Jul 2025 00:00:00 +0000

Introduction: Laryngeal papillomatosis (LP) is caused by human papillomavirus (HPV), primarily types 6 and 11. LP is a benign papillary tumor of squamous cell origin that develops in the larynx and is most observed in children. This study aims to describe the diagnostic features and clinical course of laryngeal papillomatosis, and to review recent advances in its etiopathogenesis and treatment.

Patients and Methods: We conducted a retrospective, descriptive study of 20 cases of laryngeal papillomatosis diagnosed over a 32-year period (January 1990 to December 2022) in the ENT and Head and Neck Surgery Department.

Results: The mean age of patients was 24 years, with a bimodal age distribution: a juvenile form (55%) and an adult form (45%). The cohort included 12 males (60%) and 8 females (40%). All patients underwent surgical removal of papilloma, with 13 patients (65%) also receiving adjuvant treatment with bleomycin and antiviral therapy. Tracheotomy was performed in 6 patients (30%). Outcomes included remission in 5 patients (25%), disease recurrence in 17 patients (85%), and malignant transformation in 5 patients (25%).

Conclusion: Laryngeal papillomatosis remains a challenging condition due to its complex etiopathogenesis, variable clinical presentation, and unpredictable course, which can be life threatening. LP diagnosis remains primarily clinical.

Management of pediatric acute mastoiditis: A single-center experience over two decades

Thu, 31 Jul 2025 00:00:00 +0000

Introduction: Acute mastoiditis (AM) is a rare but serious complication of acute otitis media. Controversies exist regarding the medical and/or surgical management of this condition. The aim of this study was to evaluate the effectiveness of medical approach of AM among pediatric patients.

Material and methods: We conducted a retrospective study in which we reviewed the medical records of children with AM. We included in this study patients aged less than 16 years with post-auricular inflammation and/or post-auricular tenderness and signs of acute otitis media who were treated in ENT and Pediatric Departments at our institution between 2000 and 2022.

Results: The total number was 68 patients with AM. The mean age of the population was 48 months, ranging from 6 months to 14 years. All children presented with post-auricular inflammation and signs of acute otitis media. Computed tomography (CT) of the temporal bones was performed in 52 (76.5%) children. Nineteen patients had a subperiosteal abscess and 4 children had neurological complications. All patients were immediately treated with intravenous antibiotics. Mastoidectomy was performed in 40 cases (58.8%), including 29 patients (42.6%) with uncomplicated mastoiditis and 5 patients with complicated mastoiditis, i.e. 4 cases of neurological complications, one case of facial palsy and 6 cases of subperiosteal abscess Conservative treatment including intravenous antibiotics, myringotomy and/or drainage of the subperiosteal abscess was used in 28 children (41.2%): 13 cases (46.4%) had abscess drainage combined with antibiotic treatment and the others received antibiotics only. All children recovered completely without any sequelae.

Conclusion: Conservative treatment may be considered as an initial option for uncomplicated cases, with surgery reserved for instances of medical treatment failure or the occurrence of complications. Prospective studies are needed to further substantiate this approach.

Visceral artery aneurysms encountered in General Surgery Department: A case series

Thu, 31 Jul 2025 00:00:00 +0000

Introduction: Visceral artery aneurysm (VAA) represents a complex clinical situation. On one hand, rupture can endanger the patient’s life; on the other hand, therapeutic decision-making is often marked by hesitation due to the variety of available treatment options.

Methods: This is a retrospective study of prospectively recruited patients diagnosed with VAA. The aim is to present five cases of visceral aneurysms to familiarize the medical team with these rare entities and to support the implementation of an appropriate, yet non-hasty, therapeutic approach.

Results: All patients were male, and most had a history of cardiovascular disease. Infective endocarditis was the triggering factor for VAA formation in two cases. Abdominal pain was the most commonly reported symptom. Endovascular treatment failed in most of the attempted cases. Salvage surgery was required in two patients, and elective surgery was performed in one case.

Conclusion: Due to the potential complications and the limitations of each therapeutic procedure, it is crucial to assess the patient's overall condition, including vital signs, aneurysm location, underlying cause, arterial distribution, and the availability of both interventional radiology and surgery. This comprehensive evaluation is necessary to guide an adapted and effective therapeutic choice.