[Applicability of the old european respiratory society/european community for steel and coal reference equations for spirometry interpretation in Tunisian adult population]

Tunisian pulmonary functional laboratories accept the default settings for reference equations [European Respiratory Society/European Community for Steel and Coal [ERS/ECSC1983] offered by the manufacturer even though adult Tunisian reference equations [Tunisian1995] are available. To compare the spirometric profile of Tunisian subjects, according to the two reference equations. Spirometric data were recorded from 1192 consecutive spirometry procedures in adults aged 18-60 years. Reference values and lower limits of normality [LLN] were calculated using the two reference equations. Applied definitions: large airway obstructive ventilatory defect [LAOVD]: ratio between the 1st second expiratory volume and forced vital capacity [FEV1/FVC] < LLN. Small AOVD [SAOVD]: FEV1/FVC > LLN and FVC > LLN and maximal midexpiratory flow < LLN. Tendency through a restrictive ventilatory defect [TRVD]: FEV1 and FVC < LLN. The spirometric profile, according the two reference equations, was determined. Using Tunisian1995 reference equations, 34%, 7%, 37% and 19% of spirometry records were interpreted as normal, and as having, LAOVD, SAOVD and TRVD, respectively. Using ERS/ECSC1983 reference equations, 85%, 3%, 9% and 2% of spirometry records were interpreted as normal, and as having, LAOVD, SAOVD and TRVD, respectively. Using the ERS/ECSC1983 reference equations, misclassification was worse for LAOVD, for SAOVD and for TRVD, respectively, 68%, 94% and 89%. Our results showed that the use of the old Caucasian reference equations resulted in misinterpretation of spirometry data in a significant proportion of subjects. This could result in inappropriate diagnosis and/or management

[Medical research productivity of Lebanon: a bibliometric study of papers indexed in Medline, 1985-2004]

Analysis of biomedical publications of a country is used to monitor research trends with leads to a better formulation of health policy planning and management. We sought to describe the Lebanese medical publications productivity over a 20 years period from 1985 to 2004. Medline's database was consulted and the query contained the name of the country, the medical universities, the main teaching hospitals, and cities, both in French and in English. The articles with a Lebanese health affiliation were included and the articles of dentistry, veterinary, nursing and pharmacy were excluded. We counted 1964 medical articles over a two-decade period. The productivity was 2,9 articles/100000 capita/year and 9,2 articles/ billion US dollars GDP/year. The growth rate of publication drew a decline passing from 202% [1990-1994] to 55,3% [2000-2004]. The four most productive specialties [Anesthesiology, Internal medicine, Gynecology, Pediatrics] published 611 articles [31.1%]. The governorate of Beirut, the American University of Beirut and its teaching hospital published the most with respectively 1926 [98%], 568 [28.9%], and 601 articles [30.6%]. The Lebanese medical productivity was weak and unstable mainly due to the lack of financial resources and the instability of the region. Increasing research funding, improving the physicians' research methodology and writing capacities are likely needed to improve the Lebanese medical output

[Helicobacter pylori and gastric adenocarcinoma]

Accumulating evidence for considering HP as a causal factor for gastric cancer comes from recent epidemiologic studies, the advent of an animal model of gastric cancer and from new insights in to the biological mechanisms for gastric carcinogenesis. The purpose of this review is to analyze recent data from the literature on this relationship and try to define what kinds of preventive measures could be proposed. We conducted a review of the literature through the interrogation of the MEDLINE database using a query documentary by combining the Boolean [AND] keywords [MeSH] as follows: Helicobacter pylori, stomach neoplasms. HP infection, host genetic background, food regimen are known to be involved in this cancer. There is no definite clinical evidence of the benefit of eradication on cancer risk in humans due to the lack of randomized controlled studies in large populations. Therefore HP should be eradicated in selected patients, such as patients' relatives with documented gastric cancer as well as patients having another gastrointestinal cancer

[Immunological profile of coeliac disease in a subgroup of patients with symptoms of irritable bowel syndrome]

The purpose of this study was to determine if authentic cases of irritable bowel syndrome could be secondary in a latent or potential coeliac disease. All new patients who consulted for irritable bowel syndrome fulfilling Rome II criteria between 01/04/2003 and 30/03/2004 were included. All patients had upper endoscopy with duodenal biopsy and colonoscopy or enema. Then they were investigated for celiac disease by analysis of serum IgA antigliadin, IgG antigliadin, and endomysial antibodies. One hundred patients with irritable bowel syndrome were included. They had an average age of 45.5 +/- 0.98 and they were 61 women. Clinical signs were dominated by abdominal pains associated to constipation [69% of the cases]. Five patients had positive antigliadin antibody [IgG for 2 patients and IgA for 3 patients]. None of them had endomysial antibodies nor abnormal duodenal biopsy. This study didn't provide a relation between celiac disease and irritable bowel syndrome when it is associated to constipation

Predictive factors of surgery in severe attacks of ulcerative colitis

The purpose of our study was to determine clinical, biological or endoscopic factors that predict surgery after a glucocortico steroid treatment failure in severe attacks of ulcerative colitis. Sixty one patients were analyzed. A therapeutic response for glucocorticosteroid was defined as the absence of resort to surgery within the first 30 days after hospitalization. Predictive factors were assessed using univariate and multivariate analysis. Fifteen patients [24,6%] had a medical response. In univariate analysis, predictive factors of surgery were: male sex, tobacco, number of colitis attacks in case history, temperature over 38°C, ery-throcyte sedimentation rate over 30 mm, systolic blood pressure below 11, deep and wide ulcers. During the course, bowel movements/ day over 7, pulse over 90/mn, temperature over 38°C on day 3 after treatment initiation as well as passage of blood on day 5 were identified as predictors of surgery. In multivariate analysis, bowel movements over II day on day 3 of hospitalization was independently predicted a surgery. Bowel movements/ day over 7 on day 3 of hospitalization was the only independently predictive factor of surgery after glu-cortico steroid treatment failure

[Crohn's disease: influence of age at diagnosis on clinical type of disease]

The aim of the study was to examine the influence of age at diagnosis of Crohn's disease on disease site and course in Tunisian patients

Methods: All hospital patients for Crohn's disease between 1993 and 2002 were included. They were segregated by age at diagnosis as follows: younger than 20 years, 20-39 years, and 40 years or older. And all patients were classified at the time of the latest visit into one of three subtypes of disease [non complicating, stricturing, and fistulizing] according Vienna's classification. Crohn's disease was devised also by site [ileum, ileocecal, colon and higher site]

Results: Sixty one patients [50,4%] were 20-39 years old and 43 patients [35,5%] were 40 years and older. Colonic involvement was significantly more common [46,5%] in the 40 years and older group compared with 20-39 years group [24,6%] [p=0,01]. The subtype without complication was significantly more common [58,1%] in the 40 years and older group compared with 20- 39 years group [39,3%] [p=0,05]. The frequency of the need for surgery for any indication for Crohn's disease didn't differ significantly according to age

Conclusion: In this study, Crohn's disease diagnosed in tunisian patients that were 40 years and older had often a colonic site and a less severe phenotype supporting the concept of genetic heterogeneity

[Epidemiological and clinical features of patients with type2 diabetes mellitus in health primary care facility [Sousse, Tunisie]]

As a results of epidemiologic transition, diabetes mellitus became a major public health problem in Tunisia. We tried to determine the epidemiological and clinical features of patients with type 2 diabetes mellitus in primary health care units in Sousse [Tunisia]. It was a cross sectional study about a stratified sample of 404 type 2 diabetes mellitus patients followed in primary care offices in Sousse in 2003. Average age was 60+10.9 years and sex-ratio was 0.5. Hypertension and obesity were found in respectively 71.3% and 37.6% Diabetic neuropathy was the most frequent degrenerative complication [41, 1%] followed by diabetic retinopathy [18.3%] Thus, type 2 diabetes mellitus patients, followed in primary care units show a high cardiovascular risk with serious and frequent complications. That's why, the national care program of type diabetes mellitus, in primary health care should take in consideration, in its guidelines, the clinical and epidemiological characteristics of these patients