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Introduction: Transformed progressively into a transit country towards Europe but also as a host, Tunisia has seen a diversification of migratory movements since the 2011 revolution, as well as the profiles of migrants who face multiple difficulties that can have an impact on their health.

Aim: This update aimed to expose the situation of migrants in Tunisia regarding access to healthcare, and to raise the ethical issues that result from it.

Results: Providing care to vulnerable individuals, especially migrants, compels us to reevaluate our practices and question ourselves.

Fatal rupture of hepatic adenomatosis: Autopsy case and review of the literature.

Hepatic adenomatosis is a rare disease consisting of multiple adenomas in otherwise-normal liver parenchyma. Though the discovery of this entity goes back several years, its diagnosis is still challenging in terms of its definition and pathophysiology. Clinically, patients may be completely asymptomatic and the diagnosis is only made incidentally through imaging tests.

Medical experimentation on prisoners (part 2): role of doctors in research abuses.

The involvement of physicians as an executive tool in the excesses of medical experimentation in prisons continues to raise questions and incomprehension. From the depths of the extermination camps under the Nazi regime to the iterative exploitation scandals after the Second World War, the ability of certain physicians to overstep the foundations of the Hippocratic Oath of «do no harm» and associate themselves with so many atrocities will always surprise. The answers to this question seem ambiguous because the excesses of medical experimentation in prisons should be reconsidered in their associated historical-political context.

Death by late presenting of diaphragmatic hernia in an infant: case report and review of the literature.

Background: Congenital diaphragmatic hernia (CDH) is a congenital malformation of the diaphragm, resulting in the herniation of the abdominal organs into the thoracic cavity. If not properly diagnosed before or at birth, CDH represents a life-threatening pathology in infants and a major cause of death. We present a fatal case of congenital diaphragmatic hernia corresponding to Bochdalek hernia, discovered incidentally during a sudden death's autopsy of an infant.

Predictors of evidence-based practice competency among Tunisian nursing students.

Background: Evidence-based practice (EBP) is an important competency of undergraduate nursing students which should be cultivated before graduation by increasing future healthcare providers' knowledge, skills and attitudes towards EBP. This study aimed to describe nursing students' competencies (attitudes, knowledge, skills) in Evidence-based practice (EBP) and to determine factors predicting EBP competency.

Methods: A descriptive cross-sectional study was conducted at the Higher School of Health Sciences and Techniques of Sousse (Tunisia) among 365 nursing students.

Effectiveness of an osteoporosis prevention educational program in Tunisian premenopausal women working in sedentary occupations: a quasi-experimental study.

Unlabelled: The objective of this study was to examine the effectiveness of an osteoporosis prevention program on knowledge and perception of self-efficacy in adopting preventive osteoporosis behaviors in premenopausal women working in sedentary occupations. Results show the improvement in knowledge and self-efficacy was statistically significant respectively (p < 0.001) and (p = 0.

Imported malaria in adults: about a case of cerebral malaria.

Background: Malaria is the first parasitic infection endemic in the world caused by parasites species of . Cerebral malaria (CM) is a rapidly progressive and severe form of infection, characterized by a greater accumulation of red blood cells parasitized by in the brain. The diagnosis of malaria is usually made in living patients from a blood sample taken in the course of a fever on return from an endemic country, whereas CM, often associated with fatal outcomes even in treated subjects, is usually diagnosed at autopsy.

[Medical experimentation on prisoners (part 5): ethical considerations].

Medical experimentation on prisoners is one of the most difficult ethical issues because it brings many principles into conflict with the reality of the practice. These ethical principles, which are universal and timeless, are accepted as elementary rights for every human being. However, in a detention setting, these principles are easily lost.

Characteristics of violence against women in Kairouan, Tunisia, in 2017.

Violence against women represents a serious concern worldwide. In Tunisia, despite an advanced legislative framework, we still receive women victims of violence. This survey aimed to characterize the demographic and clinical profile of women victims of violence in Kairouan, central Tunisia.

Evaluation of the Impact of Intraoperative Distractions on Teamwork, Stress, and Workload.

Background: Within the operating rooms (ORs), distractions occur on a regular basis, which affect the surgical workflow and results in the interruption of urgent tasks. This study aimed to observe the occurrence of intraoperative distractions in Tunisian ORs and evaluate associations among distractions, teamwork, workload, and stress.

Methods: This observational cross-sectional study was conducted in four different ORs (orthopedic, urology, emergency, and digestive surgery) of Sahloul University Hospital for a period of 3 mo in 2018.

Patient information in radiology: medico-legal considerations.

Information constitutes a basic right of the patient and a legal obligation of the physicians. Radiological daily practice has evolved mainly by introducing the care rule of radiologists. This active rule is leading to add new medico-legal challenges.

Assessing medical student satisfaction and interest with serious game.

Introduction: Serious games are interactive and entertaining digital software with an educational purpose, and they are increasingly being used in undergraduate medical education. Effective serious games attempt to form positive mood in order to encourage players to continue the play, leading to increased interest in gameplay and satisfaction as well as better academic performances.

Aim: To determine  the medical students' satisfaction, situational and individual interest during a serious game.

Serious Game Design with medical students as a Learning Activity for Developing the 4Cs Skills: Communication, Collaboration, Creativity and Critical Thinking: A qualitative research.

Introduction: The impact of technology in education has led to various changes in the way that different stakeholders, like students and teachers work and interact with each other. The use of the serious game design in educational contexts has been related to the development of the 21st century skills such as communication, collaboration, creativity and critical thinking.

Aim: To analyze a serious game design process by third -year medical students, from the perspective of the 21st century competencies engaged in the game design process.

Exploring patient safety culture in emergency departments: A Tunisian perspective.

Background: Emergency departments (EDs) are considered a high-risk environment because of the high frequency of adverse events that occur within. Measuring patient safety culture is an important step that assists healthcare facilities in planning actions to improve the quality of care provided to patients. This study aims to assess patient safety culture within EDs and to determine its associated factors.

Assessment of nurses' patient safety culture in 30 primary health-care centres in Tunisia.

Background: Ensuring patient safety and health-care quality remain priorities and challenges worldwide and the role of nurses is essential to meet these challenges. Developing patient safety culture is a key component to improve patient safety and health-care quality.

Aims: To assess nurses' patient safety culture in primary health-care centres in Tunisia and to determine its associated factors.

Prevalence of burnout among health sciences students and determination of its associated factors.

Burnout is a major issue among healthcare students and a public health issue in general. Indeed, the consequences of student burnout are as complex as other mental distress factors, such as those concerned with smoking and alcohol consumption, or an unhealthy lifestyle.  This study aimed to determine the prevalence of burnout among health sciences students and to determine its associated factors.

Pulmonary alveolar capillary dysplasia in infants: A rare and deadly missed diagnosis.

The pulmonary alveolocapillary dysplasia (ACD) with pulmonary vein misalignment (PVM) is a rare condition characterized by a congenital anomaly of the development of the pulmonary parenchyma. We present a case of an 8-month-old infant who died quickly from acute respiratory failure complicating an unknown ACD. We also describe its epidemiological characteristics in infants and we discuss the diagnosis's difficulties.

Assessing patient safety culture in 18 Tunisian adult intensive care units and determination of its associated factors: A multi-center study.

Purpose: This study aimed to assess patient safety culture (PSC) in intensive care units (ICUs) and to determine the factors affecting it.

Materials And Methods: This is a cross-sectional study, conducted from October to November 2017 among professionals practicing in the ICUs of the Tunisian center. After obtaining institutional ethics committee's approval and administrative authorizations, an anonymous paper-based questionnaire was distributed to the participants after obtaining their consent to take part in the study.

Script concordance test as a sanctionnal evaluation in cardiology.

Introduction: Sanctioning evaluation in cardiology is carried out using multiple choice questions, short-answer questions, clinical cases and editorial questions. However, these methods do not assess clinical reasoning in a context of uncertainty in contrast with script concordance tests (SCT).

Aim: To compare the scores obtained by the students in the 3rd year of medicine with the SCT versus the sanctioning test of cardiology and to study the correlation between these two evaluation methods.

Clinicopathological significance of cancer stem cell markers CD44 and ALDH1 expression in breast cancer.

Background: CD44 and aldehyde dehydrogenase 1 (ALDH1) has been reputed to be cancer stem cell (CSC) markers in breast cancer. Yet, the clinicopathologic and prognostic significance of these markers remain unclear. In this study, we have investigated the expression of these markers and their relation with conventional clinicopathologic tumor characteristic including molecular subtype.