Drought is one of the most common natural disasters, affecting ecosystems, agricultural production, and water supplies. This study presents the trend analysis of annual rainfall and the effect of climate variation in Tunisia. The paper seeks to provide up-to-date information for the better management of climate change in Tunisia. The analysis is based on monthly rainfall over 16 stations for a total period 62 years from 1958 to 2020 in Tunisia. The overall purpose of this study is to investigate the possible trend of rainfall variation as well as the effect of climatic changes on the study area. The Standardized Precipitation Index (SPI) and the Reconnaissance Drought Index (RDI) were employed to find long-term drought trends as well as to examine the occurrence of droughts at a longer duration. Borma and Tabarka stations have the lowest and highest extent of rainfall fluctuation with 50 and 880 mm respectively. Based on average temperature Thala and Kairouan are the coldest and warmest station in the time period of 1958–2020 with the 8.8 and 26.9 °C mean, respectively. The last ten years (2010–2020) counted as the warmest decade in the past 62 years. The mean annual rainfall varies from 200 to 900 mm for the study area. During the last decades, the time trend in rainfall has generally been in low for the southern Tunisia with an annual rainfall does not exceed 200 mm. The results of MK test for annual rainfall data revealed decreasing the trend of annual rainfall had shown non-significant decrease at all stations except at seven stations (which has a non-significant trend increase). Annual mean minimum and maximum temperatures showed increasing trend with almost same rate (0.03 °C/year) and statistically significant at 1% significant level. From the long term analysis of PET, SPI and RDI at all stations in Tunisia, it may be concluded that the annual SPI exhibited increasing trend at all station except Borma station in south but which has a non-significant trend increase. In most Tunisian regions, PET increases ranged between 0.03 and 0.52 mm annually. The north and northwestern parts of Tunisia have observed large increases in PET at rates between 0.2 and 0.52 mm year–1, in all the stations, RDI showed decreasing trend and no change trends (0.00). RDI exhibited decreasing trend in North of Tunisia. Since, non-significant positive trend showed in RDI during all stations.

This study aims to assess the impact of using different fuels in Egyptian Titan Alexandria Portland Cement Company on emissions and concentrations of pollutants (Total suspended particles (TSP), nitrogen dioxide (NO2‎), and sulfur dioxide (SO2)) and their influence on ambient air quality during the period 2014–2020 using AERMOD dispersion model. The results showed that changing the fuel from natural gas in 2014 to coal mixed with alternative fuels (Tire-Derived Fuel (TDF), Dried Sewage Sludge (DSS), and Refuse Derived Fuels (RDF)) in 2015–2020 caused fluctuating variations in pollutant emissions and concentrations. The highest and lowest maximum concentrations of TSP occurred in 2017 and 2014 respectively, where the TSP is positively correlated with coal, RDF, and DSS and negatively correlated with natural gas, diesel, and TDF. Also, the lowest and highest maximum NO2 concentrations were detected in 2020 and 2016 followed by 2017 respectively, where NO2 is positively correlated with DSS and negatively correlated with TDF and varies with diesel, coal, and RDF. Moreover, the maximum concentrations of SO2 were the lowest in 2018 and highest in 2016 followed by 2017 because of its considerable positive correlation with natural gas and DSS and negative correlation with RDF, TDF, and coal. Generally, it was found that increasing the percentage of TDF and RDF with decreasing the percentage of DSS, diesel, and coal will reduce pollutant emissions and concentrations and enhance ambient air quality.

Objectives:To assess the association between plasma C-type lectin-like receptor 2 (CLEC-2) and ST elevation myocardial infarction (STEMI) and its correlation with clinicolaboratory data.

Methods:

This case-control study included 88 individuals divided into two groups. Group I (the cases group): 50 patients diagnosed with STEMI. Group II (control group): 38 sex-matched and age-matched healthy individuals. All patients were subjected to the assessment of CLEC-2, using enzyme-linked immunosorbent assay (ELIZA) kit.

Results:

CLEC-2 levels in group I were higher than group II (P value <0.001). CLEC-2 serum levels were not affected by the site of MI, site of occluded vessels, and systolic function. CLEC-2 serum levels were higher in patients with dilated left ventricle and those with diastolic dysfunction; however, these findings were not statistically significant. By using the ROC curve for determining the possibility of using CLEC-2 as a marker for STEMI it showed that the best cutoff value is >121, area under the curve 0.73, sensitivity 76%, specificity 63.2% (P < 0.001), 95 CI (0.63–0.84).

Conclusions:

CLEC-2 levels can be used as a diagnostic marker but not suitable to be a prognostic factor.

BackgroundSeasonal influenza vaccines (SIVs) can protect against influenza and substantially reduce the risk of influenza-related hospitalizations and fatalities in children. This study aimed to assess parental attitudes towards SIVs in the Eastern Mediterranean region (EMR).
Methods
Through an anonymous online survey conducted in 19 countries in the EMR, parents or caregivers over 18 years who had at least one child above 6 months filled out the Parent Attitudes about Childhood Vaccines questionnaire. As data had two levels; country and individual factors, we utilized multilevel binary logistic regression models.
Results
In total, 6992 respondents filled out the questionnaire. Of them, 47.4 % were residents of middle-income countries, 72.4 % of the mothers were between 26 and 45 years old, 56.5 % had at least a university degree, and approximately 51.6 % were unemployed. Nearly 50.8 % of the respondents were hesitant to vaccinate their children against seasonal influenza. Parental attitudes towards seasonal influenza vaccination differed significantly between countries, p < 0.001. The main predictors of parental seasonal influenza vaccine hesitancy (VH) were parents vaccination (odds ratio (OR) = 0.42, 95 % CI = 0.32–0.55, p < 0.001)), the mother's education if mother educated vs. who did not receive any education (OR ranged from 0.48 to 0.64, p < 0.05), living in low-income countries (OR = 0.52, 95 % CI = 0.35–0.77, p < 0.01), mountain residence (0.69, 95 % CI = 0.49–0.99, p < 0.05), health workers as a source of information (OR = 0.70, 95 % CI = 0.58–0.85, p < 0.001), children vaccination against COVID-19 (OR = 0.52, 95 % CI = 0.41–0.65, p < 0.001), not receiving routine vaccinations (OR = 1.93, 95 % CI = 1.09–3.44, p = 0.025), and if parents respondents could not remember whether their child had suffered from seasonal influenza in the previous year (OR = 1.57, 95 % CI = 1.33–1.84, p < 0.001).
Conclusion
A high seasonal influenza VH rate was found in the EMR. Health authorities should implement different interventions targeting the identified modifiable risk factor to increase vaccine uptake among children, especially those at risk of complication from seasonal influenza infection.

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Absent azygos vein is a rare anomaly of the venous system, which is commonly an incidental finding, with only few publications reporting it. Due to the scarcity of cases, it is rarely reported with oesophageal atresia ± tracheoesophageal fistula (OA ± TOF), which is usually accompanied with cardiac anomalies in up to 80% of the cases. This association has only been reported thrice in literature. We report a 6-day-old female who was referred to our centre after diagnosis of OA + TOF. The patient had no associated anomalies apart from small patent foramen ovale and small ventricular septal defect; however, there was no functional compromise. Upon thoracoscopic exploration, azygos vein could not be visualised. Thoracoscopic repair was performed, and the postoperative period was uneventful. On follow-up, the patient had no postoperative complications. Absent azygos vein is a rare anomaly with few cases reported throughout the literature. Azygos vein is considered an important landmark intraoperatively because it guides the surgeon to the TOF site. Moreover, it might be important in other patients with major cardiac anomalies with abnormal venous drainage who might need further surgical correction.

Absent azygos vein is a rare anomaly of the venous system, which is commonly an incidental finding, with only few publications reporting it. Due to the scarcity of cases, it is rarely reported with oesophageal atresia ± tracheoesophageal fistula (OA ± TOF), which is usually accompanied with cardiac anomalies in up to 80% of the cases. This association has only been reported thrice in literature. We report a 6-day-old female who was referred to our centre after diagnosis of OA + TOF. The patient had no associated anomalies apart from small patent foramen ovale and small ventricular septal defect; however, there was no functional compromise. Upon thoracoscopic exploration, azygos vein could not be visualised. Thoracoscopic repair was performed, and the postoperative period was uneventful. On follow-up, the patient had no postoperative complications. Absent azygos vein is a rare anomaly with few cases reported throughout the literature. Azygos vein is considered an important landmark intraoperatively because it guides the surgeon to the TOF site. Moreover, it might be important in other patients with major cardiac anomalies with abnormal venous drainage who might need further surgical correction.

Background: Early caries detection became mandatory in modern dentistry. However, the traditional methods in caries detection had many limitations. Hence, a novel approach based on Near Infrared technology was introduced to overcome such limitations. Material and methods: Proximal surfaces of 102 posterior teeth from 36 adult participants who fulfilled the eligibility criteria were assessed by two examiners using three diagnostic methods. Teeth were examined visually according to the criteria of the International Caries Detection and Assessment System (ICDAS-II) then examined by bitewing digital radiograph (BW) and near infrared light transillumination (NIRT) camera (Vista Proxi iX HD smart). Inter and intra observer agreements were assessed using Kappa test. Diagnostic accuracy parameters and Area Under the ROC curve (AUROC) with 95% confidence interval (95% CI) were evaluated for the different caries assessment methods. Results: The results of inter-observer agreement showed an excellent agreement in the different groups. There was a statistically significant difference in the score distribution between ICDASII and VistaCam modalities (P-value <0.05). While there was no statistically significant difference in the score distribution between bitewing radiography and VistaCam modalities (P-value >0.05). ROC curve analysis revealed that VistaCam when compared with ICDASII had sensitivity (99.0%), specificity (50.0 %), diagnostic accuracy (98.0%) and Area under the ROC curve (AUC) was 0.745 with 95% Confidence Interval (0.649 - 0.826). When VistaCam compared with bitewing radiography, it showed sensitivity (100.0%); specificity (40.0%), diagnostic accuracy (97.1%) and AUC (0.700) with 95% confidence interval (0.601 - 0.787). Conclusions: NIRT based diagnostic modality is a promising method for detection of hidden proximal lesions overcoming the hazards of radiograph. Key words:Bitewing radiography , ICDAS II , Near-infrared transillumination, proximal caries, VistaCam® iX Proxi.

Background: We aimed to evaluate the ability of inferior vena cava (IVC) distensibility using the transhepatic approach to predict fluid responsiveness in mechanically ventilated patients with septic shock after emergency laparotomy. Methods: This prospective observational study included mechanically ventilated paralyzed adult who had septic shock after emergency laparotomy. The IVC dimensions were measured through the transhepatic and subxiphoid approaches. The fluid responsiveness was confirmed with >15% increase in cardiac output after 500 mL of fluid bolus. The outcomes were the ability of transhepatic (primary outcome) and subxiphoid approach to predict fluid responders using the area under the receiver operating characteristics curve analysis. The gray zone for the two approaches was calculated. Results: Data from 51 patients were analyzed, and the number of fluid responders was 30 of 52 (58%). The transhepatic approach was feasible in all patients, whereas the subxiphoid approach was only feasible in 42 patients. The area under the receiver operating characteristics curve (95% confidence interval) for the transhepatic IVC distensibility was 0.88 (0.76-0.95), and it was comparable with that of the subxiphoid approach (0.81 [0.66-0.92], P = 0.417). The gray zone for the transhepatic IVC distensibility was 17% to 35% including 24 of 51 patients (47%), whereas the gray zone for the subxiphoid IVC distensibility was 13% to 34% including 18 of 42 patients (43%). Conclusion: In conclusion, the transhepatic approach for evaluation of IVC distensibility showed good accuracy in predicting fluid responsiveness in patients with septic shock after emergency laparotomy. The transhepatic approach showed the same accuracy as the subxiphoid approach with the advantage of being feasible in larger number of patients.