[Immunophenotyping in adult acute myeloid leukemia: which prognostic value?]

Immunophenotyping is an essential step in the diagnosis of acute myeloid leukemia. Its prognostic value remains controversial with contradictory results. To assess prognostic impact of the immunophenotyping in AML. Our study is retrospective [October, 2005 - July, 2007] concerning 56 cases of AML [AML3 excluded] of the adult from 18 to 55 years old diagnosed and treated in Tunis Aziza Othmana Hospital. The immunophenotyping was performed by flow cytometry [Beckman Coulter EPICS XL MCL [registered sign]. We studied clinical and biological characteristic, immunophenotypic expressions, and parameters of the response to the treatment: complete remission [CR], overall survival [OS], relapse free survival [RFS] and relapse in a delay of 1 year and 2 years. SPSS software was used to perform the statistical analysis. The median age of the patients is of 37.7 +/- 11.8 years. Sex-ratio [M/F] is 1.33. Among individual antigenic expressions, only CD7 is associated to lower CR rates [p=0.044]. We did not find any statistically significant association between immunophenotypic expressions and OS nor with relapse or RFS. The impact of immunophenotyping in AML remains controversial because of contradictory results. The research of molecular changes would be an interesting alternative in our context

[Medical demography in Tunisia: current situation and perspectives]

Health human resources management is one of the important determinants of health care access equity.To analyse the trend of Tunisian medical density during 2000-2009 and to predict its situation by 2024. Current medical density was calculated using Bar Council of Physicians of Tunisia database. Medical density was calculated and analysed for the period 2000-2009 then modelled by 2024 [estimate of needs and supply]. The active medical density raised by 36% during the period 2000-2009 with a higher increase for specialists. The proportion of non-active physicians rose from 4.6% to 15.2% in 2009. Increasing feminization of medical density and persistence of its regional disparities. By the year 2024, 217 physicians for 100,000 inhabitants would be required while the supply would correspond to 212/100 000 inhabitants. Medical human resources have indeed globally improved. However, some lacks remain and adequate measures are required, based on a rational planning directed to satisfy the population needs and to allow health equity

[Opinion of the population of Tunis about the physician social image]

The image of the Tunisian doctor seems to have lost some of its aura and social value. To evaluate the medical profession's social image and to identify the reasons of a possible dissatisfaction by interviewing a sample of 200 adults in the District of Tunis. Population was selected according to the method of quotas depending of sex, age and instruction degree. One hundred and ninety nine persons aged 20 years and above were included. Collection of data was made by an interview and included 4 items: identification of respondent, expected qualities of medical doctor, satisfaction level regarding health services, comparison between general medicine and specialists. Chi-2 test was done for comparison of proportions. In order to classify professions according to income and prestige a score was calculated. It ranged from 10% [10th rank] to 100% [1[st] rank]. Patience and availability were quoted as particularly essential requirements in a doctor. Yet only 35.7% of the interviewees reported being satisfied by their doctor's qualities. A general dissatisfaction regarding health services was also noted. Our sample's perception of professional prestige rated industrials over doctors by placing them in first position. With regards to the perception of best-paid jobs, doctors were classed third after industrials and important traders. In order to counter these deficiencies and to preserve doctors' social image and their place in society, it is imperative to change our understanding of their training and recycling and also to improve their purchasing power as it is the unquestionable guarantee of the preservation and durability of their public image

[Return to work after acute myocardial infarction]

The aim of this work to study the professional repercussions of acute myocardial infraction and to analysis medical, social and occupational factors which could influence return to work. Our study concerns 70 patients less than 66 years old, working before their hospitalization and having been admitted for acute myocardial infraction between January 1[st], 1999 and December 31, 2000 in the Department of Cardiac Resuscitation of hospital La Rabta of Tunis. Data were collected from retrospective review of folders and answers to a questionnaire for which the patients have been summoned in 2002. There were 70 patients almost exclusively men [n=69]. The mean age was 49.0 +/- 6.8 years. The mean follow-up was 27.2 +/- 7.7 months. Sixty one patients [87.1%] have initially been back to work and eight of them lost it secondarily. The average delay of return to work has been 91 +/- 111 days. The direct repercussions of myocardial infraction on the preofessional capacities was observed at the majority of patients. Despite an important professtional repercussions of acute myocardial infraction, our study showed a high rate of return to work with relatively short delays

Cout direct medical de la prise en charge de l'infarctus du myocarde en phase algue

to assess the medical direct cost of acute myocardial infarction. Method: data are recorded through a prospective study in 7 wards of cardiology of the District of Tunis during one year: from November 2001 to October 2002. cost of hospital stay, biologic analyses, drugs, functional investigations and possible non surgical cardiologic intervention [IC] was calculated. 632 AMI cases are recorded, the death rate is 7.8%. The average of hospital stay was 13.3 days. 49.1% of patients benefited from thrombolytic therapy, 55.5% benefited from a coronary angiography and 16.1% of an act of IC. The mean of direct cost [CGM] was 2171 Tunisian Dinars and the median was 1731 DT, of whom room costs 31.7%, 22.5% acts of IC, 7.2% drugs, 26.2% functional investigations and 12.4% biological analyses. The mean cost of IC was 3030 +/- 401 DT. The methodology of our study remains original in our country and can be used to assess the other aspects of AMI as other diseases cost management

Prevention secondaire des maladies cardiovasculaires: Connaissances et pratiques des malades

The aim of our study is to assess the degree of awareness and practices of patients with cardiovascular disease. Method: During October 2002- February 2003, we conducted a CAP study [Knowledge, attitudes, behaviors] at some outpatient clinic visit of Tunis District. Using a standardized questionnaire, investigators have collected demographic and personal data, informations about risk factor levels, knowledge and attitudinal characteristics related to risk factors for patients who satisfied the inclusion criteria. 443 patients have been interviewed [68.4% are men]; 40% have more than 65 years old. Half of patients have never been schooled. Most of them have low socioeconomic level [38.8%] or middle one [56.0%]. 66.9% of men have quitted tobacco smoking and 19.5% still smoking 41.3% of patients have some difficulties to change their lifestyle, The difference is statically significant by educational and occupational levels. Almost 60% of them used to practice daily a moderate physical activity, which was more frequent among men then women [p<0.01]. During the last year, majority of patients has had checked their blood pressure [98%], glycaemia [94%] and cholesterolemia [94%]. However, about 57% to 67% of patients knew if they have hypertension, diabetes or hypercholesterolemia. Most of patients are aware that healthy lifestyle can be important in preventing heart attacks and stroke and that control of blood pressure, cholesterolemia and glycaemia reduce recurrence of these attacks once they happened. CVDs prevention and control is facing the crucial question on lifestyle change and enhancing patients responsibility in their own health promotion

Prise en charge de l'hypertension arterielle: Resultats d'une enquete Tunisienne aupres des medicins generalistes

The control of arterial hypertension [HT] is an endlessly hoped objective but usually not reached. Several factors are determinants. The physician role is crucial in the HT prevention. In order to evaluate knowledge's, attitudes and behaviors of Tunisian physicians in HT management, we conducted a cross sectional study in 2002 using a self administered questionnaire addressed to physicians working in private and public sectors. 380 generalists participated to this study. 95,5% of them confirmed that HT constitutes a public health problem. 81,1% saw at least 4 patients with HT a week. 95% insisted on the importance of the primary prevention. 90% took care themselves patients. 71,5% confirmed the importance of a training and an entrainment for the measure of the blood pressure [BP]. 3,7% made diagnosis after a single visit and 10,9% confirmed it only from described symptoms. 20,4% of the generalists chose the old classification as objective level of BP thiazidic Diuretics and 13 blockers were most prescribed medicines in first intention. 9,4% stopped the treatment after stabilization of blood pressure. 60% of generalists had inadequate behavior facing a not stabilized BP Non observance of treatment by patients was indicated by 31% of the generalists, cost and break of the medicines' stock and disappearance of symptoms were the main causes advanced by the generalists. This study shows the existence of gaps in generalists' practical behavior treating this disease. Measures aiming the medical practice improvement turn out necessary in particular the sensitization of the generalists by an adequate university training and a continuous medical training, and a regular evaluation of the national program of hypertension prevention and management