Comparative clinical trial: fluconazole alone or associated with topical ketoconazole in the treatment of pityriasis versicolor

Background: The efficacy of ketoconazole and fluconazole in pityriasis versicolor had been proved

Aim: To compare the efficacy and the safety of two doses of fluconazole given 1 week apart alone or associated to ketoconazole shampoo

Methods: Our study included all patients with pityriasis versicolor who attended in dermatology department of Habib Thameur Hospital, Tunis [over a 21-month period]. During the considered period, patients were randomly assigned in two study groups: G1 receiving fluconazole two doses 300mg given 1 week apart with G2 taken an association of fluconazole [two doses 300mg given 1 week apart] and ketoconazole shampoo the first day

Results: Seventy one patients were enrolled in our study: 35 in the fluconazole group and 36 in the fluconazole associated to ketoconazole shampoo comparator group. The mean age was 29.1 years [16-70 years]. Concerning the clinical form, 27% had macular lesions, 24% had plaques and 49% had mixed form. Lesions werehyperchromic52%; hypochromic 15% and erythematous 6%. As for main location, 67% had lesions on the neck; 66% on the trunk, 60% on the shoulders. At the end of the study, there was no significant difference in clinical presentation and in improvement rate of pityriasis versicolor between fluconazole and association of fluconazole and ketoconazole shampoo [[p=0.13 at day 14, p=0.57 at day 28 and p=0.2 at day56]

Conclusion: In this study, we have shown that the improvement rate of PV treated with two doses of 300 mg of fluconazole with one week interval was similar to those of an association of one application of ketoconazole shampoo and the same dose of fluconazole

Prognostic factors in children with extracranial malignant germ cell tumors: a monocentric pediatric Tunisian study

Background: Extracranial Germ cell tumors [GCT] are a rare and a heterogeneous group of pediatric cancers but highly curable

Aim: We aimed to review management, outcome and prognostic factors that influence overall survival [OS] in a pediatric Tunisian oncologic unit

Methods: We retrospectively evaluated between January 1998 and December 2012, 33 patients affected by extracranial germ cell tumors and treated according to TGM95 protocol established by the SFOPin a pediatric Tunisian oncologic unit

Results: Patients had a mean age of 57 months [ranges: 1 day-13 years]. There were 19 girls and 14 boys. Primary sites included 12 sacrococcygeal, 11 ovarian, 6 testicular, 3retro peritoneal and 1 mediastinal site. After a mean follow up of 26.1 months [ranges: 0-96 months], OSat 2 years and 5 years were respectively 82% and 75%. Event-free survival were respectively 79% at 2 years and 74% at 5 years. Various prognostic factors have been studied according to Kaplan-Meier. Univariate analyses identified significant factors which influence strongly OS: the stage [p=0.04], the completeness of surgery [p<0.001] and the relapse [p = 0, 0001]. A multivariate study showed that only the quality of resection and the clinical stage remained strong significant prognostic factors [p=0,021] for 5-year OS

Conclusion: Disease stage, completeness of surgery and relapse have been established as the most powerful prognostic parameter in our analysis. The improvement of survival of patients affected by extracranial germ cell tumors in Tunisia is a real achievement mainly due to the success of salvage treatments

High risk areas for echinococcosis-hydatidosis in Tunisia

The study was conducted in order to identify high risk areas for hydatidosis in Tunisia witch would be eligible for a Hydatidosis control program initiation. The most recent epidemiological investigation on surgical incidence of hydatidosis was used to classify governorates according to their incidence rate. A [global hydatidosis risk score] was calculated for each governorate, combining some parameters related to the hygiene conditions of the population, the literacy rate, the canine density and livestock census. Spearman correlation coefficient was used to compare scores and surgical incidences. Mapping analysis has been conducted. The surgical incidence rate of hydatidosis classifies each governorate regarding occurrence of human cases. The global hydatidosis risk score, by governorate, pointed out the most exposed areas to the disease. The mapping analysis showed a good agreement between the incidence rate of the disease and the global hydatidosis risk score and made it possible to identify the population of the center and the west of the country as a most exposed population for the diseases. In order to have a chance for implementation, hydatidosis control program should target the three jointed governorates of Kasserine, Siliana and Kef, which have the highest incidence rates and the worst scores

Predictive score for positive upper endoscopies outcomes in children with upper gastrointestinal bleeding

Background: Upper gastrointestinal bleeding [UGIB] is a common pediatric emergency. Esophago-gastro-duodenoscopy [EGD] is the first line diagnostic procedure to identify the source of bleeding. However etiology of UGIB remains unknown in 20% of cases. Furthermore, emergency endoscopy is unavailable in many hospitals in our country

Aims: Identify clinical predictors of positive upper endoscopy outcomes and develop a clinical prediction rule from these parameters

Methods:Retrospective study of EGDs performed in children with first episode of UGIB, in the endoscopic unit of Children's Hospital of Tunis, during a period of six years. Statistical analysis used SPSS20. Univariate analysis was performed and multivariate logistic regression was then modelled to derive a clinical prediction rule

Results: We collected 655 endoscopies [23.2% normal, 76.8% pathological]. We found that time to EGD within 24 hours from the onset of bleeding [p=0.027; Adj OR: 3.30 [1.14 - 9.53]], rebleeding [p=0.009; Adj OR: 6.01 [1.57 - 23.02]], positive gastric lavage outcome [p=0.001; Adj OR: 4.79 [1.95 - 11.79]] and non steroidal anti-inflammatory drugs intake [p=0.035; Adj OR: 5.66 [1.13 - 28.31]] were predictors of positive upper endoscopy outcomes. By assigning each factor, the adjusted odds ratio [Adj OR], we developed a score with four items, ranging from 4 to 20. Using the receiver operating characteristic [ROC] curve the best cut off >/= 9 was defined [sensitivity 88.2%, specificity 60.6%, positive predictive value 92.7% and negative predictive value 47.6%]. The score discriminated well with a ROC curve area of 0.837 [95% confidence interval [0.769 - 0.905]]

Conclusions: This clinical prediction rule is a simple measure that may identify children who needed emergency endoscopy. A prospective study is required to validate our results and evaluate other clinical features that were insufficient for this analysis

[Clinicobiological and morphological profiles of primary sclerosing cholangitis in Tunisia]

Primary sclerosing cholangitis [PSC] is a chronic cholestatic disease strongly associated, in the western series, to inflammatory bowel disease [IBD] and particularly to chronic ulcerative colitis. North African data are rare. To study the epidemiological, clinicobiological and morphological profile of PSC in Tunisia. A retrospective multicenter study extended over a period of 14 years [1995-2009], including all patients suffering from PSC, hospitalized in the four participants departments. We collected epidemiological, clinico-biological, histopathologic and morphological data for each patient. We brought together 33 patients [22 men and 11 women], middle aged 44 years. The disease was symptomatic in 73% of cases. Laboratory tests showed cholestasis [100%] associated with hyperbilirubinemia [72%] and a moderate cytolysis [78%]. Morphological analysis of bile ducts by cholangioMRI or endoscopic retrograde cholangio-pancreatography objectified diffuse damage of the biliary tract in 61% of cases. Association with IBD was found in 33% of cases [Crohn's Disease: 27%, chronic ulcerative colitis: 6%]. An association with autoimmune hepatitis was found in 6% of cases and primary biliary cirrhosis in 3% of cases. PSC is rare in Tunisia and affects men more often than women. The association with IBD is less frequent than in literature. It concerns essentially Crohn's disease. These data require confirmation by prospective multicenter studies

randomized, controlled trial of nebulized 5% hypertonic saline and mixed 5% hypertonic saline with epinephrine in bronchiolitis

Bronchiolitis is a public health problem in the word and in Tunisia. Nebulized hypertonic saline seems to have some benefits in bronchiolitis. The aim of this study is to evaluate the efficacy of nebulized 5% hypertonic saline alone or mixed with epinephrine in bronchiolitis as measured by improvement in clinical score, oxygen saturation or reduction in duration of hospitalization. This prospective, double blind, placebo controlled, randomized clinical trial was performed at Children's Hospital of Tunis from February 2012 to Mars 2012. A total of 94 patients less than 12 months of age with diagnosis of moderately severe bronchiolitis were enrolled and assigned to receive 5% nebulized hypertonic saline, mixed 5% hypertonic saline with standard epinephrine 0,1% or normal saline [placebo] at admission and every 4 hours during hospitalization. There were no significant difference between nebulized 5% hypertonic saline, mixed 5% hypertonic saline with epinephrine or normal saline at baseline, T30 min, T60 min, and T120 min after start study in Wang severity score, oxygen saturation in room air, rate respiratory and heart rate. There was no difference in duration of hospitalization. Nebulized 5% hypertonic saline or mixed 5% hypertonic saline with epinephrine are safety but does not appear effective in treating moderately ill infants with the first acute bronchiolitis

[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

Health-related quality of life assessment on 100 tunisian patients with ankylosing spondylitis using the sf-36 survey

The main objective of the study was to examine the self reported health status in patients with ankylosing spondylitis [AS] compared with the general population and the secondary objective [in the AS group] was to study the association between health status, demographic parameters, and specific disease instruments in AS. A cross sectional study of 100 AS patients recruited between 2006 and 2009 at the Department of Rheumatology. Health status was assessed by using the SF-36 health questionnaire in patients with AS. Demographic characteristics and diseasespecific instruments were also examined by the questionnaire. A sample of 112 healthy individuals was also surveyed using the SF- 36 health questionnaire. This study showed a great impairment in the quality of life of patients with AS involving all scales. All male patients with AS reported significantly impaired health-related quality of life on all items of the SF-36 compared with the general population whereas female patients reported poorer health on three items only, namely physical functioning, general health and bodily pain. Mental health was mostly affected than physical role. The physical role was significantly higher in patients with high education level than in patients with low education level [p=0.01]. Physical functioning was better in employed patients. All scales of SF-36 were correlated with BASFI, BASDAI and BAS-G. Only physical functioning and general health were correlated with BASMI. Impairment in the quality of life can be significant when suffering from AS, affecting mental health more than physical health. Among disease parameters, functional impairment, disease activity, mobility limitation, and spinal pain were the most associated factors resulting to the deterioration of quality of life

[Effect of inhaled corticosteroids on bone mineral density in asthmatic adults: a 20 cases study]

Inhaled corticosteroids are widely used in the treatment of asthma but their safety on bone density is controversial. To study in a population of adults with asthma receiving inhaled corticosteroids for long term, the effect of this therapy on bone mineral density. Prospective study including 20 asthmatics, aged from 20 to 45 years, treated with inhaled corticosteroids for 12 months or more, with no risk factors for osteoporosis. We compared osteodensitometric parameters in our patients, bone mass and T-score at vertebral and femoral witness to a population matched by age and sex. The average age of our patients was 35.45 +/- 5.43 years and the average BMI was 30.03 +/- 5.77 kg/m2. The average daily dose of corticosteroid was 925 +/- 133.27g of equivalent of beclometasone with an average take of 33.5 +/- 21.3 months. The vertebral site bone mass average was 1216 +/- 0106 g/cm2 in the studied group and 1201 +/- 0099 g/cm2 in the control group without significant difference [p = 0380]. At femur, the bone mass average was 1037 +/- 0143 g/cm2 in the patient group and 1056 +/- 0107 g/cm2 in the control group [p = 0380]. We did not find a significant link between bone mineral density and cumulative dose or the duration of taking inhaled corticosteroids, BMI and tobacco. Our work confirms like other previous studies the safety of inhaled corticosteroids on bone mineral density

[Palliative chemotherapy of non small lung cancer in Tunisia. prospective study of the cost and impact on the quality of life]

Bronchopulmonary cancer is actually the first cancer in the world. In Tunisia, recent statistics are alarmous. The most bronchopulmonary cancer in tunisian series are diagnosis at metastatic states. To evaluate the cost of the global treatment by chemotherapy in patients with metastatic non small lung cancer and its impact over the quality of life in Tunisia. It's a prospective study lead between January 2006 and Juin 2007 to evaluate the quality of life for patients hading metastatic non small lung cancer treated by palliative chemotherapy in Ibn Nafiss department in Abderrahmen Mami hospital.The evaluation of the qualitt of life is inspired by the questionnary of EORTC: QLQC30 version 3 translated in en arab langage, filled before chemotherapy, after the le 3rdcycle, and at the end of the first ligne. The study of the cost is effectued for the 2 protocols whose the most used in first ligne: Cisplatin-Vinorelbine [P-V] and Cisplatin- Gemcitabine [P-G]. 30 patients had benefit from palliative chemotherapy based on P-V [18 cases] or P-G [12 cases]. All patients had responded for the questionnary in the opportunt moments. After 3 cycles of chemotherapy, we note an improve of the symtomatic, physical, activity, emotional and global health scales. In opposition, we note a deterioration of cognitive and social scales without any supplementary improvement[no significant difference] if we add other cycles in the twice protocols. At the same level of the benefit in term of quality of life and survival without supplementary toxicity, the choice is made by the less cost's protocol in other words P-V. Our results confirm the benefit from chemotherapy in term of survival and quality of life in our context, howewer, the important cost of the chemotherapy necessitate to rationnalize the indications and the le choice of the treatments in this palliative indication

[Obesity hypoventilation syndrome and obstructive sleep apnes syndrome: what kint of association?]

Severe obesity sometimes leads to a chronic alveolar hypoventilation: obesity hypoventilation syndrome [OHS], [Pao2<70mmHG, Paco2>45mmHG and body mass index [BMI]>30Kg/m2]. The association with an OSAS is frequent. To assess predicting factors that lead to hypoventilation in a population of obese patients with SAS and to deduct the type of association between OHS and SAS. We have study during 4 years, at pneumology service of Charles Nicolle hospital, 62 obese patients [BMI>30Kg /m2], 41men and 21 women and presenting an OSAS. We excluded those carriers of a bronchial obstruction [VEMS/CV <60%] and we have compared anthropom‚triques, functional, gazom‚triques and polysomographiques details of the groupe1 [G1]: OHS=9 and of the groupe2 [G2]: obesity without hypoventilation [n=53]. We didn't identified any significant difference between the two groups concerning [age, sex, the frequency of smokers, the frequency of the nasopharynx region abnormalities, apnea-hypopnea index [AHI], the SAS severity and the respiratory functional exploration]. The obesity is significant more important in the G1, it is sever [BMI>40] in 77.8% of patients of the G1 with significant difference with the G2 [P=0.004]. We noted that there is a positive interrelationship between BMI and Paco2. We identified severe gazom‚trique perturbation in G1 [Pao2 medium = 61 +/- 9 mmHg,Paco2 medium=50 +/- 7 mmHg], in the G2 we noted a moderate hypoxemia. Patients of the group1 make of the minimal desaturation of 63 +/- 17% and a Sao2 average of 81 +/- 20% what is meaningfully more important than in the G2. The alveolar hypoventilation in SAS seems to be in correlation with the degree of obesity. The hypercapnie in the OHS is in relation neither with the SAOS nor with its severity. The OHSSAS association is usual but not synonym; the OHS is an autonomous disease

[Autoimmune hepatitis in Tunisia. Retrospective multicentric study about 83 cases]

Autoimmune hepatitis [AIH] is a chronic inflammatory condition of the liver of unknown etiology. Its epidemiological and anatomoclinical characteristics and its outcome were unknown in Tunisia. To analyse epidemiological, anatomoclinical, immunological and histological aspects of AIH and to determine factors predicting relapse after treatment and death of this disease in Tunisia. Patients presenting with AIH between January 1996 and December 2004 were evaluated in retrospective multicentric study. The diagnosis of AIH was established according to the criteria of the revised score of the international autoimmune hepatitis group [1999].Eighty three patients were identified [70 female; mean age = 49 + 17,9 years]. 63% presented probable AIH and 5% of cases were type II HAI. Fifty seven percent of the patients were cirrhotic at presentation. Associated autoimmune diseases was seen in 27 patients, dominated by diabetes, autoimmune thyroiditis and SjOgren's syndrome. An overlap syndrome was diagnosed in 25% of cases; primary biliary Cirrhosis-AIH in 20% of cases and primary sclerosing cholangitis-AIH in 5% of cases. Fifty patients were treated by glucocorticoids as monotherapy or in combination with azathioprine. Complete remission was achieved in 90% of cases. Fourteen percent relapsed within a median time of 12 months. Factors associated with relapse were: treatment with Azathioprine <18 months, absence of lobular necrosis and anti-nuclear antibody [+] profile. Mortality was observed in 17% of cases. Factors associated with death were encephalopathy as an independent factor and treatment with Azathioprine <18 months. In Tunisia, epidemiological and clinical characteristics of AIH were similar to those reported in the literature but with a higher frequency of cirrhosis at presentation. Treatment with Azathioprine <18 months was the main factor associated with relapse and represented with encephalopathy a factor associated with death

Utility of lumbar puncture for febrile seizures among infants under one year old.

Febrile seizure is a frequent cause of hospitalization. Its management remains problematic According to the American Academy of Pediatrics, lumbar puncture, which is not devoid of risk, is strongly recommended in infants under 1 year. To define the utility of lumbar puncture in the management of febrile seizures in infants under 12 months and to identify risk factors of meningitis and to respond to this question: " lumbar puncure should be done in which infant with febrile seizure?" This retrospective study was conducted in the department of pediatrics B in the Children Hospital of Tunis on eight-year period [2000-2008]. In all statistical tests, significance level was set at 0.05. One hundred and six cases were collected during the period of study. Seizures related to bacterial meningitis were seen in 11 cases [10%]. We have separated two groups: GI infants presented bacterial meningitis, and G2 infants with febrile seizure. The comparison between the two groups G1 and G2 showed the following predictors factors of meningitis: age 5mm [p<0.001], recurrence of seizure in the same day[p=0,006], neurological abnormalities p<0.001], CRP>20 mg/1[p=0.03], hyponatremia

[Validation of the Tunisian versions of bath ankylosing spondylitis functional index [BASFI] and disease activity index [BASDAI]]

The Bath Ankylosing Spondylitis Functional Index [BASFI] and the Bath Ankylosing Spondylitis Disease Activity [BASDAI] are the most commonly used instruments to evaluate respectively functioning and disease activity in ankylosing spondylitis [AS]. The aim of this study was to translate, adapt and validate these instruments into the Tunisian language. The studied population consisted of 68 AS patients [59 males and 9 females]. Their mean age was 37.9 years [range: 18-76]. The mean disease duration was 13.6 years [range: 1-40].After translation and retranslation the BASFI and BASDAI questionnaires were administrated to the patients and tested for reliability, internal consistency and construct validity. The reproducibility of the indices BASFI and BASFAI was good, the intraclass correlation coefficient for reliability was 0.96 [CCI: 0.93-0.97] for the BASFI and 0.93 [CCI: 0.90 -0.97] for the BASDAI, and the coefficient of internal consistency [Cronbach's alpha] was 0.91 for BASFI and 0.90 for BASDAI. Concerning construct validity, both questionnaires were significantly correlated to each other, to the disease-specific instruments [BASG-s, BASMI, BASRI, ASQoL] and to all domains of the SF-36. The Tunisian versions of the BASFI and the BASDAI preserve the metrological properties of the original versions and were easy to use for the assessment of disease status in ankylosing spondylitis

[Postpartum levels of glycosylated hemoglobin in mothers of large baby: a prospective study]

The delivery of a large baby may indicate that the mother had abnormal glucose tolerance during pregnancy. Glycosylated hemoglobin [HbA1c] concentration might be expected to identify women who had high blood glucose concentration before delivery. The aim of this study was to identify retrospectively, gestational diabetes in mothers of large baby and determine the HbA1c cutoff value. HbA1 was measured in 216 patients within the first three days of postpartum: 100 had large babies: weighing over than 4000g and 113 had normal-sized babies [control group]. We exclude mothers who had preterm, hypotrophy baby, stillborn, and diabetic mothers. The mean concentration of HbA1c was significantly higher in group with large babies than in group control [6.17%+ 085 vs 5.17+0.571=9.78 p<0.001]. The value of HbA1c=5.85%, evaluated by ROC curve, was considered as risk factor of macrosomia and then gestational diabetes. 83.5%of mothers with large babies had HbA1c 7 5.85 vs 7.8%of those with normal sized babies [p<0.0001]. No other significant differences were found between the two groups in other parameters. HbA1 c level may be of value as a postpartum screen for unrecognized diabetes and may help discriminate between a constitutionally large but otherwise normal newborn and a large infant of a diabetic mother. HbA1c measurements should be obtained in women with large babies, and, if upper than cutoff value found by curve ROC: 5.85%, maternal and fetal surveillance is recommended

[Vitamins A, E and leptin in obese and non insulin dependent diabetes group]

At the obese ones, there is an imbalance between the free defenses antioxydants and radicals from where the installation of an oxydative stress, responsible for the development of non-insulin dependent diabetes. Our objectives was to evaluate the levels of vitamins A, E and of leptin, to search the link witch could exist between vitamins and leptin. We proportioned the rates in vitamins A, E and in leptine at 30 obese subjects diabetic of type 2 including 12 men and 18 women of average age [50,93 +/- 6,13] years not carrying pathologies other than the diabetes and obesity compared to 30 witnesses who theirs are paired according to the age and the sex. Our results chows that levels of antioxidants did not differ between the two groups but we find a non significant decrease in vitamin El [TC +TG] ratio [1,86 +/- 0,38 VS 2,11 +/- 0,74 ; p=0,08] and significant increase of vitamin A level in women obese with non-insulin-diabetes mellitus compared with control group of women [0,69 +/- 0,16 V.S 0,55 +/- 0,15 ; p=0,01]. Moreover a negative and significative correlation between vitamin E and leptin [r=0,452 p=0,01], and a negative and no significative correlation between vitamin A and leptin [2=-0,221 ; p>0,05] were observed. the rate of vitamin A, is different for each sex with share. The vitamin E could have a negative control on the secretion of the leptin

[Incidence of mucopolysaccharidoses in Tunisia]

The mucopolysaccharidoses [MPS] are a devastating heterogenous group of lysosomal storage disorders. To evaluate the epidemiological profile of MPS in Tunisia Methods we conducted a retrospective epidemiological survey covering the period 1970-2005. Multiple sources were used to identify affected patients. Ninety six confirmed MPS cases were collected from 132 suspected cases found in the surveyed data. Of the ninety six confirmed cases. 20%were from multiplex families. Consanguinity was found in 83%of the families. The crude rate for all types of mucopolysaccharidoses was 2.3 cases in 100,000 live births. The prevalence of MPS type I, III and IV, those most frequently occurring in the collected data, were estimated at 0.63, 0.7 and 0.45 per 100.000 live births, respectively. The cumulative incidence of MPS type VI [0.3 per 105 live births] was higher than reported in European countries; but, it is likely that. The reported frequency of all types of MPS in Tunisia is underestimated

[ randomized, controlled trial of nebulized terbutaline in the first acute bronchiolitis in infant less than 12 months old]

Despite the common clinical practice, the available evidence on the efficacy of bronchodilators therapy for bronchiolitis is conflicting. The aim of this study is to evaluate the efficacy of nebulized terbutaline in bronchiolitis as measured by improvement in clinical score, oxygen saturation or reduction in duration of hospitalization. This prospective, double blind, placebo controlled, randomized clinical trial was performed at Children's Hospital of Tunis from December 2004 to April 2006. A total of 35 patients less than 12 months of age with diagnosis of moderately severe bronchiolitis were enrolled and assigned to receive nebulized terbutaline or normal saline placebo at admission [TO], at 30 minutes after admission [T30] and every four hours during a study period. Outcome measurements included: Respiratory Distress Assessment Instrument [RDAI] score, respiratory rate, oxygen saturation, heart rate and the duration of hospitalization. There were no significant difference between terbutaline and placebo at baseline, T30 min, T60 min, and T120 min after start study in RDAI score, oxygen saturation in room air, rate respiratory and heart rate. There was no difference in duration of hospitalization. Nebulized terbutaline therapy does not appear effective in treating moderately ill infants with the first acute bronchiolitis

[Biologic profile in tunisian infants [0 - 2 years] malnourished]

The malnutrition of the infants could be explained by a delay of the growth and the perturbation of biological parameters. To establish the nutritional profile of the Tunisian infant of less than two years. To specify the principal deficiencies and the possible origins of these deficiencies. In our transverse exploratory study, carried out in period of 9 month. This study was conducted in two groups of Tunisian young children less than two years old: a control group and a malnourished group [Z score >/= -2SD]. Our data consolidate the important impact of pregnant women nutritional state and of breastfeeding on the foetus ant infant growth.Compared to control infants, the malnourished young showed a significant alteration of different biologic parameters. This alteration appeared positively linked to the gravity of malnutrition as indicated by the positive relation obtained between the weight/height ratio and many studied parameters. The malnourished infants showed, notably, a significant reduction of the average values of Chol-HDL, apo AI, Vit E, TSH and TF4 levels and Chol-HDL/Chol LDL ratio. Chol-HDL, apo AI and HDL/Chol-LDL are found positively and significantly correlated with TF4. So, their reduction in ill children would be, at least in part, a side effect of the thyroid function reduction. Our results confirm the existence of an important change of biological profile in malnourished young children. Besides, they emphasize that studies about young children could be helpful, notably, in the prevention and the fight against atherosclerosis

[Tunisian children reference for body mass index and prevalence of obesity]

The prevalence of obesity in children is known to be increasing rapidly worldwide but few population-based surveys have been undertaken in North Africa and in the Middle East. Report the means of body mass index with values corresponding to the different percentiles in boys and girls by age from a large nationally representative sample of the Tunisian children population. The second aim was to estimate the prevalence of obesity and over weight in children and adolescent using the 85th and 95th body mass index percentile respectively derived from the U.S.A first National Health and Nutrition Survey and also the International cut off points for body mass index for overweight and obesity proposed by the International Obesity Task Force and Rolland Cachera. We have used data from the Tunisian National Nutrition Survey, a cross sectional health study providing a large nationally representative sample of the Tunisian population including 3885 children and adolescent. The mean of BMI was of 16.63 +/- 2.58 Kg/m[2] among boys and 17.36 +/- 3.52 Kg/m[2] a in girls. The BMI increased with age and more precociously in girls [10 years] that in boys [13-14 years]. The rnean+2SD of the BMI approached the 95th percentile. It is noticed that our 85th percentile and 95th percentile as well in the girls and in boys were lower than the same percentiles of the children of other countries [NHANES I, IOTF] and that our 97th percentile is higher than that of the French according to tables of Roland Cachera. By considering the NHANES I and the IOTF, the prevalence of obesity were rather weak [<5%] but high according to the tables of Roland Cachera [3 to 11%]. The prevalence of obesity was low in 1996 according to references of the NHANES I and IOTF but high according to tables' of Roland Cachera. Prevention of obesity by a healthy way of life remains the most effective means in the long and undoubtedly less expensive realizing programs of regular monitoring