[Osteoporosis in tunisian major beta thalassemic patients a study of 64 pediatric cases]

Osteoporosis has been described extensively in adult thalassemics. Fewer studies have been reported in thalassemic children. Study the frequency and outcome of osteoporosis in Tunisian major beta thalassemic children and to identify principal clinical risk factors and biological characteristics of its occurrence. It's a prospective study enrolled between 1 January and 31 December 2008. 64 thalassemic major patients were evaluated. The study of bone mineral density was provided by X-ray photon. Osteoporosis was defined by Z score beta -2SD at lumbar [L1-L4] sites. 30 of patients studied [46.87 per cent] had a Z score beta 2-SD. Compared with non-osteoporotic patients we have identified as risk factors: the age of the patient [p = 0.001]. The number of transfusion [p = 0.002] and the increased of the annual consumption of blood [p = 0.02]. We found a larger number of growth retardation [p =0.004]. Iron overload was greater in the group of osteoporotic patients [p = 0.04]. The sex, age at diagnosis, the average of hemoglobin, the status of viral hepatitis B and C, the incidence of allo or auto-immunization, and thyroid status seem to have no influence the occurrence of osteoporosis in our study. The onset of osteoporosis is associated directly to higher transfusion requirements and age > 12 years

[Laryngotracheobronchial foreign body in children: predictive factors of respiratory sequelae]

Inhalation of laryngotracheobronchial foreign body in children is a serious accident that may compromise the prognosis of the child and the respiratory function in the long term. Aim: identify the predictive factors of respiratory sequelae of laryngotracheobronchial foreign body inhalation. This retrospective study was conducted in the children hospital of Tunis during a period of nine years [2000 - 2008]. In all statistical tests, the significance level was set at 0.05. 60 children were included in the study. The average age was 24.9 +/- 3.4 months. 2 / 3 of the children were boys. The foreign body was plant in 80% of cases. The penetration syndrome was reported in 83.7% of cases. The average time of stay of foreign body was 14 days. The chest radiograph was abnormal in 77.4% of cases. Endoscopic extraction was performed in 59 cases and a pneumectomy was conducted in one child. 30 children were followed for an average of 23 months. 18 children had not respiratory sequelae [clinical, radiological and scintigraphic]. 10 children had respiratory sequelae [clinical and radiological and/or scintigraphic] at the last follow-up and four patients developed bronchial dilatation. Respiratory sequelae were correlated with the stay period of the foreign body exceeding 84H. Neither age, nor sex, nor the nature of foreign body or its location, nor the presence of radiological opacity at the initial radiograph, were predictive factors of respiratory sequelae. The inhalation of foreign body is a serious accident affecting essentially male infants. Clinical, radiological and scintigraphic follow up is mandatory

[Evaluation of the maternal death system in public facilities in the Tunis [1999-2004]]

We report the performance indicators in 2004 of a follow-up on the system for recording maternal deaths which was established in 1999. The system was operating in 69.8% of public hospitals, and 96% of maternal deaths investigations were completed. In 69.8% of maternal deaths there was a direct obstetric cause. Haemorrhage was the major cause of maternal death [30.8%], followed by eclampsia [11%]. The proportion of avoidable [certain or possible] deaths was 75.3%. There were problems in evaluation of risk presented by women and inadequate follow-up during the postpartum period and delay in appropriate treatment. Incomplete documentation and difficulty in ascertaining avoidability were problems faced by the regional follow-up committee

[Overlap syndrome autoimmune hepatitis=primary biliary cirrhosis. Comparative study with isolated autoimmune hepatitis results of a multicentric Tunisian]

Autoimmune hepatitis [AIR] and primary biliary cirrhosis [PBC] are two autoimmune diseases affecting the liver. Suggestive signs of the two diseases can however occur simultaneously or consecutively in the same patient leading to an overlap syndrome. The aim of our multicentric retrospective study was to study clinical, biological, immunological and histological features of 17 patients with overlap syndrome and to compare them with those of 62 patients with isolated autoimmune hepatitis. Overlap syndrome "AIH-PBC" accounts for 20,5%of patients with autoimmune hepatitis in our series. Our two groups were similar in age and gender. Clinically, in overlap syndrome group, a significantly higher prevalence of pruritus arid significantly lower prevalence of ascites were observed as compared to isolated AIH group. No significant differences were observed between the two groups of patients with regard to frequency of concurrent immune diseases. Biologically, serum alkaline phosphatase and garnma-glutamyl-transpeptidase were significantly higher in overlap syndrome than in patients with isolated AIH. Significantly more overlap syndrome patients were positive for anti-mitochondrial antibodies than isolated AIR patients. The patients with isolated AIR had a higher frequency of cirrhosis at presentation that the patients with overlap syndrome. The histologic profile was not different between isolated AIR and Overlap syndrome. Overlap syndrome "AIR-PBC" is not rare. Compared with isolated AIH, it is characterised by a higher frequency of clinical and biological signs of cholestasis, a higher frequency of antimitochondrial antibodies and the rarity of cirrhosis at the diagnosis of the disease

[Health transition in Tunisia over the past 50 years]

We describe the dramatic demographic, socioeconomic and health changes witnessed in Tunisia over the past 50 years. Demographically, the gross mortality rate and the infant mortality rate have gone from 19 per 1000 and 150 per 1000 respectively in 1956 to 5.7 per 1000 and 26.2 per 1000 now, and life expectancy at birth going from 50 to 72 years for the same period. Socioeconomically, the urban population has risen from 25% to 62%, the literacy rate from 15% to 73%, and the per capita income has increased 5-fold in real terms. Epidemiologically, the infectious and perinatal diseases prevailing in the 1960s have decreased whereas chronic and degenerative diseases have risen. The proportion of the GNP related to health expenditure has risen from 3.8% to 6.2%. The implication of these changes on the Tunisian health system and the need to adapt in terms of curative care and prevention of risks are discussed

[Food intake during and outside Ramadan]

We explored the effect of fasting in the month of Ramadan on the dietary pattern of a group of 130 healthy adults. During Ramadan, there was an increase in total energy intake, as a result of protein and lipid intake but not carbohydrate intake compared to the diet througout the rest of the year, in both students and parents. The meal eaten after sunset was an important contributor to calories [65%], lipids [74%], proteins [71%] and carbohydrates [56%]. These findings show the eating behaviour during Ramadan may contribute to improved nutritional status of people at risk of nutritional deficiency