Prevalence of and factors associated with smoking among students in Sousse, Tunisia

Within the framework of the fight against tobacco among young people, we conducted a descriptive cross-sectional study in 2013 to estimate the prevalence of smoking and to identify associated factors among students in Sousse. A questionnaire was administered to a representative sample of 556 students in 5 academic institutions in Sousse randomly drawn. The age of the participants was between 17 and 35 years. The prevalence le of tobacco consumption in the past 12 months was 22.1% and consumption during the past 3 months was 65.3%. The average age of starting smoking was 17 years. Smoking prevalence was significantly higher for males [P <0.001] and those aged over 25 years [P-0.002]. Students from 2 of the institutions were using more tobacco than their colleagues in the other institutions [P= 0.027]. The high prevalence of smoking found among the students means that prevention measures are essential; this requires increasing self-esteem and evaluating intervention programmes implemented before smoking the first cigarette

Modelling of seasonal influenza and estimation of the burden in Tunisia

The burden of influenza was estimated from surveillance data in Tunisia using epidemiological parameters of transmission with WHO classical tools and mathematical modelling. The incidence rates of influenza-associated influenza-like illness [ILI] per 100 000 were 18 735 in 2012/2013 season; 5536 in 2013/14 and 12 602 in 2014/15. The estimated proportions of influenza-associated ILI in the total outpatient load were 3.16%; 0.86% and 1.98% in the 3 seasons respectively. Distribution of influenza viruses among positive patients was: A[H3N2] 15.5%; A[H1N1] pdm2009 39.2%; and B virus 45.3% in 2014/2015 season. From the estimated numbers of symptomatic cases, we estimated that the critical proportions of the population that should be vaccinated were 15%, 4% and 10% respectively. Running the model for the different values of R0, we quantified the number of symptomatic clinical cases, the clinical attack rates, the symptomatic clinical attack rates and the number of deaths. More realistic versions of this model and improved estimates of parameters from surveillance data will strengthen the estimation of the burden of influenza

Epidemiology and medical cost of hospitalization due to rotavirus gastroenteritis among children under 5 years of age in the central-east of Tunisia

Data on the economic burden of rotavirus infection in Tunisia are needed to inform the decision to include rotavirus in routine childhood immunizations. This study aimed to describe the epidemiological profile of rotavirus disease in central-east Tunisia and to estimate its hospital cost. In the first stage - the prospective collection of epidemiological data - we enrolled all patients < 5 years old who were hospitalized for acute diarrhoea at 5 university paediatric departments in central-east Tunisia during the period 2009-2011. Rotavirus was responsible for 65 [23.3%] of the 279 cases enrolled. In the second stage, cost data were collected retrospectively using an activity-based costing method from the medical records of the children who were positively diagnosed with rotavirus. The average cost of care per child was TD 433 [SD 134]. This is a significant economic burden in Tunisia, where a safe and effective vaccine is available but not yet introduced to the immunization schedule

Epidemiological and chronological profile of preterm birth in the region of Monastir [Tunisia] between 1994 and 2012

Data about the profile and risk factors of premature births in Tunisia are scarce. The objective of this study was to describe the epidemiological profile of preterm births in Monastir, Tunisia, and to study the chronological trends of associated factors over the years 1994-2012. A population-based study was conducted using data from the regional births database on all deliveries in public maternity units. The overall prevalence of preterm births among the 161 116 deliveries in the 19-year period was 5.60% [95% CI: 5.13%-6.07%]. The rate of preterm births and of adequate prenatal care increased significantly over the study period. Extremes of maternal age [/= 35 years], having a twin pregnancy and the occurrence of complications during pregnancy were significant predictors of prematurity in the final regression model. Efforts should be made to improve the quality of health care in the region, especially for high-risk pregnancies

Carcinome epidermoide du larynx chez la femme

Le cancer du larynx est assez rare chez la femme. Cependant; il risque d'etre en recrudescence a cause de l'augmentation du tabagisme feminin. Peu de travaux se sont consacres a rechercher les specificites du cancer du larynx chez la femme. But: Analyser le profil epidemiologique et clinique des femmes porteuses d'un carcinome epidermoide du larynx et degager les caracteristiques therapeutiques; evolutives et les facteurs pronostiques chez cette population. Methodes: etude retrospective portant sur 50 femmes prises en charge pour un carcinome epidermoide du larynx sur une periode de treize ans (1994-2006). Resultats : L'age moyen de nos patientes etait de 63;5 ans. L'intoxication tabagique etait retrouvee chez 32;6 des patientes. Chez 30 de nos patientes aucun facteur de risque n'a ete retrouve. Les signes cliniques etaient domines par la dysphonie suivie de la dyspnee et la dysphagie. Les tumeurs prenaient naissanceau depend de l'etage glottique dans 55;8 des cas. Nous avons releve que 60;4 des tumeurs etaient vus a un stade evolue T3-T4 et que 95;3des tumeurs etaient initialement classees N0. La chirurgie a ete pratiquee chez 47;5 des patientes tandis que 16;2 ont recu une radio-chimiotherapie. La survie globale cumulee etait de 78;8 a 3 ans et de 73;5 a 5 ans. Conclusion : L'absence des facteurs de risque classiques chez un grand nombre de nos patientes laisse supposer le role d'autres facteurs etiopathogeniques dans la genese du cancer du larynx chez la femme. Toute dysphonie chez la femme doit etre exploree meme en l'absence de facteurs de risque. La prise en charge et le pronostic semblent superposables a celui de l'homme

Reasons for using emergency departments of major hospitals in Greater Tunis

Tunisia, similar to many countries, has a problem of overcrowd ing of the emergency departments [ED]. This study aimed to analyse the reasons for using EDs, and to describe the seriousness of the attendees' condition and their itinerary before their arrival at ED. This cross-sectional study in 2009 was conducted in ED of 4 hospitals in GreaterTunis and targeted 1058 patients of both sexes, aged >/= 18 years, with stratification according to time of day of presentation to ED [morning, afternoon and evening]. Information was recorded on the sociodemographic characteristics of the study participants, reasons for choosing ED, time of and reason for consultation, diagnosis and severity of illness. Over half the patients [52.5%] were male and the mean age was 46.0 [SD 18.1] years. The main reasons for choosing the ED were: speed [54.0%] and ease of access [47.7%] of ER and occurrence of an acute episode [26.4%], Patients with serious illness accounted for only 6.3% of those interviewed. Implementation of good practices and better coordination between public and private services and the ED are needed to reduce unnecessary visits to ED

Ochronosis: report of two familial cases

Ochronosis of alkaptonuria is a rare hereditary autosomal recessive disease in wich there is an absence of homogentisic acid oxidase resulting in accumulation of homogentisic acid in tissues. To report a new case of alkaptonuria. A 49-year-old man had been followed for 4 years for chronic lombalgia and arthropaty of two knees. He is married to his cousin and father of 4 girls. His parents are also cousins. The clinical examination has found a cutanuous pigmentation and a lumbar stiffness. At biological checking, creatininemia was at 190 micro mol/L and there are not inflammatory indicators. The radiography have shown a discal dorsolumbar calcifications, anterior inter somatic bridges and bilateral arthritis of knees without articular chondrocalcinosis. The diagnosis of ochronosis have been suspected and confirmed by the blackness of urine and the dosage of alkaptonuria. The patient has been treated symptomatiquely. Familial investigation have revealed that his daughter suffred from the same disease with the notion of blackness of urine. She is 12 year old and she's asymptomatic on the osteoarticular level. Alkaptonuria causes a degenerative arthropaty wich can endanger functional prognosis. Early diagnosis and scanning of this innate error of metabolism by genetic study play a fundamental interest, especially for molecular and genetic advisement

[Location and bowel subcellular liver of aluminium and administered indium oral rat]

Aluminium and indium are two elements used in industrial and medical fields. The purpose of this work was to study the subcellular localization of these elements, after their single and simultaneous oral administration to rats. 2h after the administration of these two elements, the small intestine and the liver were removed. Ultrastructural study showed the presence of electron dense deposits in the lysosomes of apical parts of duodenal enterocytes. When the minerals were administered simultaneously, deposits were observed in lysosomes of duodenal and jejunal enterocytes. No deposits were seen in the hepatic tissue of treated and control rats. Microanalysis identification showed that the deposits are constituted of aluminium, indium as well as phosphorus. Our results suggested that the elements are concentrated, in lysosomes, under the form of insoluble phosphate salts and it seemed that there are no specific lysosomes for the concentration of minerals since the two elements were concentrated in the same lysosome when they are administered simultaneously

[Generalized pustular psoriasis activated by Klebsiella pneumoniae septicaemia]

Generalized pustular psoriasis is a severe form of psoriasis. The pustular dermatosis complicates a known psoriasis frequently after a medicinal taking or infection. It exceptionally inaugurates the psoriatic disease. We report a case of generalized pustular psoriasis triggered by Klebsiella pneumoniae septicaemia and discuss the characteristics of this association. A 43-year-old man, was hospitalized for a profuse pustular eruption evolving for one week with altered general state, fever and liquid diarrhea. The patient ate a tuna sandwich 48 hours prior to the onset of symptoms. The biology showed a hyperleucocytosis, elevated C Reactive Protein and hepatic cytolysis. The skin histology demonstrated a pustular psoriasis. Three blood samples, a coproculture and a catheter culture showed Klebsiella pneumoniae. The patient was treated with antibiotics. The pustular psoriasis was treated by acitretin. The evolution was gradually favourable. Generalized pustular psoriasis is a rare and severe affection. Its prognosis is mainly conditioned by infectious complications

[Psoriasis indicative of HIV infection progress to aids]

Psoriasis is a chronic inflammatory dermatosis which can appear before HIV infection in a patient with personal or family histories of psoriasis or which can be triggered by the HIV infection in a previously unaffected subject. The psoriasis with HIV is often more severe and refractory to classic psoriasis treatments. We report a case of psoriasis that revealed an HIV infection at the AIDS stage, and shall discuss the clinical and therapeutic characteristics of this association. A 40-year-old female has presented with a non pruriginous erythemato-squamous face and scalp eruption with palomplantar keratoderma and onychodystrophy of all toe nails evolving for one ear. On physical examination, an oral candidosis and chronic diarrhea were also noted. The diagnosis of common psoriasis was evoked and the investigations had revealed a lymphopenia at 610/mm[3]. The HIV serology was positive with CD4 at 31/mm[3] and viral load at 31,000 copies/ ml. A chest radiography had shown an apical left opacity due to pulmonary tuberculosis. In few days, the psoriasis extended to the whole integument. The patient was treated by antiretroviral therapy, antituberculosis drugs and local corticosteroids and ointments for her psoriasis. The evolution was quickly favourable. The recent psoriasis developed in an unaffected subject or the exacerbation of a former psoriasis can be associated with immune-suppression. HIV serology is required in such cases

[Liver involvement in Gaucher's disease: a tunisian cohort study]

Gaucher disease is a sphingolipidosis related to glucocerebroside storage in reticuloendothelial cells leading to multisystemic disease. Liver involvement is frequent but clinical expression is rare. The aim of this study is to evaluate liver involvement among a cohort of 45 patients with type 1 Gaucher disease. Hepatomegaly often mild to moderate was seen in 86 per cent of cases. A correlation was noted between hepatic involvement, spleen enlargement and severity index score. Portal hypertension was documented in 20 per cent of cases and seemed to be primitive. Four children had cirrhosis and two a hepatopulmonary syndrome. Splenectomised patient didn't show worsening of liver involvement. Liver complications were more frequent in pediatric patients comparatively to adult patients in this cohort

[Left multiocular cystic nephroma: a pediatric case report]

The authors reports a clinical case of cystic nephroma in a 12-year-old girl which the data non specific clinics and the character little informative exams of imagery contribute to make difficult the diagnosis of this rare affection. Only histologic studies affirm the diagnosis

[Pneumococcal meningitis: clinical features and prognostic factors]

Despite advances in antibiotic therapy strategies and pediatric intensive care, prognosis of Streptococcus pneumoniae meningitis remains very poor. To determine epidemiological and clinical features of pneumococcal meningitis and the factors associated with hospital mortality and neurologic sequelae. We conducted a retrospective study of 21 cases of childhood pneumococcal meningitis admitted in the department B of the Children hospital of Tunis during a 9-year-period. Twenty one children were included in this study. The mean of age was 22 months. 10 children had presented seizures before admission and one was admitted in coma. The direct examination of the cerebrospinal fluid was positive in 85 per cent soluble antigens were positive in 66 per cent and the culture was positive in 100 per cent. Immediate complication were notified in 9 cases and neurosensorial sequelae in 6 cases. Pneumococcal meningitis is a serious disease with a high rate morbidity and mortality then, we suggest introducing pneumococcal vaccine

[Phenotypic spectrum of zellweger syndrome about three cases]

Peroxisome biogenesis disorders associate the spectrum of Zellweger syndrome and Rhizomelic chondrodysplasy. We have studied two cases of Zellweger syndrome and a case of neonatal adrenoleucodystrohpy. Clinical picture consisted with neonatal hypotonia with seizures in all cases, facial dysmorphia in two cases and a punctata chondrodysplasia in one case. Deafness and blindness were found in two cases. Cerebral tomography revealed white matter hypodensities in all cases. The diagnosis of Zellweger syndrome was enhanced by high level of plasmatic very-long-chain fatty acids and deficiency of DHAP-AT activity and b oxidation of C26:0 in fibroblasts. Ultrastructural studies showed peroxisomal ghosts in one patient. Genetic analysis detected a punctual mutation on PEX 26 gene. The prognosis was poor with the death of the two Zellweger at the age of 9 month with resistant seizures, and at the age of 4 years for the ALD. The prenatal diagnosis was performed in one family

[Hereditary spherocytosis]

Hereditary spherocytosis [HS] is a constitutional disease of red corpuscles. Hereditary pattern is autosomic dominant in 80 percent of the cases. It is usually appeared in childhood by regenerative anaemia of variable gravity. It can be symptomatic in the neonatal period. Jaundice is the first and more frequent symptom. Through two observations of HS with neonatal revelation, we carry clinical, biological and therapeutic particularities of this affection in neonatal period

Ketosis-onset diabetes in Tunisian adults: immunological markers and beta-cell function

The aim of this study in Tunisia was to classify ketosis-onset diabetes in adult patients. All patients aged >/= 30 years without known diabetes, presenting with ketosis and admitted to our department were studied. Patients with secondary or gestational diabetes and those on corticoid therapy or with coinciding infection were excluded. The data included clinical characteristics, immunological markers and beta-cell function. Of the 63 patients, islet-cell antibodies were present in 27.0%, glutamic acid decarboxylase antibodies in 25.4% and thyrosin phosphatase antibodies in 19.0%. beta-cell functional reserve was preserved in 54.0%. Our results confirm that patients with ketosis-onset diabetes mellitus in adulthood are a heterogeneous group

Rifampicin and colistin in the treatment of infections from multiresistant acinetobacter baumannii

Nosocomial infections by Acinetobacter baumannii are responsible for an increase in mortality and the duration of hospitalization. Imipenem represented during main years the 'Gold standard' in the treatment of infections due to Acinetobacter baumannii, however the emergence of resistances to this molecule in many hospitals constitutes a significant therapeutic challenge. The good sensitivity of this germ invitro to colistine, increased by the association of rifampicine supported the intravenous use of these antibiotics in vivo. We report our experience with rifampicine-colistine association for the treatment of infections due to Acinetobacter baumannii multiresistant in the surgical resuscitation unit of the CHU Sahloul of Sousse

Metoclopramid methemoglobinemia: a rare cause of neonatal cyanosis

The authors report three cases of methemoglobinemia diagnosed in premature. The new-borns presented isolated cyanosis. All explorations were normal. Diagnosis of methemoglobinemia was confirmed by a high blood rate of methemoglobin. Over dose of metoclopramid related to an error of its administration was noted. The authors recall physio-pathology, diagnosis, causes and treatment of acquired methemoglobinemia, while insisting on necessity of primary prevention

Sirenomelia: report of two cases

Sirenomelia is a serious congenital deformity in which the legs are fused together, giving the appearance of a mermaid [of the Greek Mythology], Its prevalence has been estimated at about 1, 5 to 2 in 100 000 births. We report two cases of foetuses with Sirenomelia. The first case is that of a premature baby weighing 1050g. The second case is a premature baby resulting from a triple pregnancy and weighing 1450g. They presented a fused lower limb and absent kidneys, anus and external genitalia. They died rapidly. These two cases will allow us to debate the clinical signs, the aetiology and the prognosis of such congenital malformation as well as the difficulties of prenatal diagnosis