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

[Emergency department visits for respiratory symptoms in the greater Tunis, between 2007 and 2010]

Background: Asthma and Chronic Obstructive pulmonary Disease [COPD] are considered as a major public health problem worldwide. They are characterized by a progressive evolution with episodes of exacerbations

Objective: The aim of this work was to describe the emergency department visits for asthma and COPD according to sociodemographic characteristics of patients and to assess trends over time

Methods:We conducted a cross sectional study including all emergency department visits of the Abderrahmane Mami hospital during the period between January, 1st 2007 and the 31th of December 2010. We used a standardized questionnaire to collect age; sex and date of emergency department visits with a primary diagnosis of asthma and COPD exacerbation from the emergency register. Data analyses were performed with SPSS 17.0

Results: A total of 9814 emergency department visits were reported over the period of four years, 6499 [66,2%] for asthma and 3315 [33,8%] for COPD exacerbation. The mean age was 52 +/- 21 years; it was for asthma and COPD respectively 48 +/- 21 and 60 +/- 18 years. Aging was associated with a marked decrease in the prevalence of asthma [from 51.0% to 25.6%] and with a marked increase in the prevalence of COPD [from 6.8% to 47.5%]. Men visit most frequently the emergency department for both diseases than women and particularly for COPD where the proportion of men was 75%. The number of visits increased steadily between 2007 and 2010, it peaked in January for asthma and in February for COPD and it was most important on the period from December to May

Conclusion: Asthma was most common among emergency department visits than COPD exacerbation, it affects men and women in a nearly same proportions and it is most frequent in young adults aged between 30 and 65 years. COPD exacerbation is most frequent in men aged over 65 years. Our study suggests that there is significant seasonal variation in the emergency department visits for respiratory illness. These findings suggest that greater attention and most adapted studies should be necessary to explain and to identify factors implied in these variations

[Aboriginal malaria in Tunisia: about the 4 cases registered in 2013 in Tunis]

Background: Malaria has been eliminated in Tunisia since 1979, but the country remains, like all other countries harboring the vector, exposed to the potential risk of resurgence

Objectives: Describe the clinical and epidemiological investigation of 4 cases of autochthonous malaria in July 2013 and report the main actions of regional and national response

Methods: Retrospective descriptive survey of the 4 clinical observations as well as the study of the regional report data of basic health care for the region of Tunis in 2013

Results: Febrile table concomitant for 4 Tunisian male patients, aged from 21 to 27 years old ; fortuitous discovery of Plasmodium falciparum when checking thrombocytopenia of patient 1 ; diagnosis in cascade of other cases following the epidemiological investigation and field consultation with clinicians ; 3 simple forms and a neuromalaria of favorable evolution ; negative entomological survey for anopheles ; elimination of imported malaria and blood-borne ; airport malaria highly probable. The response included the establishment of a regional and national monitoring unit, an information program aimed at health professionals concerned and public opinion, the involvement of health and entomology teams for the detection and census of potential larval habitats and the implementation of local mosquito eradication measures

Conclusion: The clinical vigilance and competent biologist's eye is necessary to prevent the resurgence of this disease. The epidemiological surveillance system should be maintained and kept as well as the food safety standards monitoring at the borders

[Kaposi's disease: epidemiological, clinical, anatomopathological and therapeutic features in 75 patients]

Kaposi's sarcoma [KS] is a mutifocal angiogenic process characterized by cellular and vascular proliferation. To identify the epidemio-clinical, histological and therapeutic features of KS. Retrospective study of 75 cases of KS at the dermatology department of Rabta hospital in Tunis during a period of 25 years [1982-2007]. Three epidemio-clinical forms of KS were observed in our study: the classic KS [70 cases], the AIDS-related KS [4 cases] and the iatrogenic KS [1 case]. The mean age of our patients at diagnosis was 69.16 years with a sex ratio of 2.33. Elective site of cutaneous lesions in the classic KS was the limbs [87.1%]. The cephalic part was concerned in 17.1% of cases. Mucosal involvement was found in 28.5% of patients. Extra dermatological localizations of KS were observed in 32.9%. Our study identified some epidemio-clinical features of the classic KS especially the high frequency of mucosal and cephalic involvement as well as extra dermatological localizations. Thus further exploration is required even without alarm signs

[Epidemiology of acute hematogenous osteomyelitis in children: a prospective study over a 32 months period]

To determine the demographic, clinical, biological and bacteriological profile of acute community acquired hematogenous osteomyelitis [AHO] in children. Prospective study including children admitted for AHO. We noted the demographic parameters of patients and the clinical, biological and radiological characteristics of the infection. Blood cultures and local specimen in operated children were systematically performed. 70 patients were included. The mean age was 7.7 years. The mean time between onset of symptoms and admission was 3.2 days. Distal tibia was the most frequent localization [18.66%]. Fever higher than 38[degree sign] on admission was found in 92.8% of patients. Creactive protein [CRP] was superior to 20 mg / L in 95.8% and ESR superior to 20 mm in the first hour in 92% of cases. A deep venous thrombosis was found in 7 patients and a pleuropulmonary Staphylococcus infection in 4 patients. Amicroorganism was isolated in 64.7% of cases. Staphylococcus aureus methicillin susceptible [SAMS] was the predominant germ. Staphylococcus aureus methicillin resistant [SAMR] accounted for 15.7% of staphylococcus aureus infections. The importance of CRP on admission and time to resolution of fever after the start of treatment were significantly higher in SAMR infections. The existence of deep venous thrombosis and a pleuropulmonary Staphylococcus infection and the need for surgical drainage were significantly more frequent in SAMR infections. The existence of a severe form of AHO should lead to a high suspicion of SAMR infection and prompt the prescription of an appropriate antibiotiotherapy

[Intestinal parasites in food handlers region of Tunis: 8502 study stool samples [1998-2008]]

The food handlers control is one of the major measures of the National program against intestinal parasitoses in Tunisia. The collected data allow regular updates of the prevalence and profile of the involved parasitic species and note possible evolutions in time. From 1998 to 2008, 8502 stool samples of food handlers working in Tunis area were examined in the laboratory of Parasitology, Pasteur Institute of Tunis. The mean prevalence of intestinal parasites was 13.5% [1152 positive samples]. The protozoa were the most detected parasites [93% of the species observed]. Among the pathogenic or potentially pathogenic parasites, Dientamoeba fragilis [15.5%] and Giardia intestinalis [7.6%] were the most frequently encountered. Entamoeba [E.] histolytica/dispar was diagnosed in 41 subjects [a prevalence of 0.5%]. Hymenolepis nana was the most frequent helminth [4.5% of the whole parasites]. Therapeutic failures were noticed in 43.8% of infection by this cestode because of the lack of the appropr iate antihelminthic. The identification using PCR of cysts and/or vegetative forms of E. histolytica/dispar revealed the exclusive presence of E. dispar

[Ambulatory blood pressure measurement control in hypertensive treated diabetic patients]

Good blood pressure control is one of the recommended targets in diabetic patient's management.To evaluate blood pressure [BP] control in hypertensive treated diabetic patients using ambulatory blood pressure measurement [ABPM]. Two hundred and six hypertensive treated diabetic patients were enrolled in this study [83 men and 123 women]. Mean age were 60.3 +/- 9.6 years-old with mean diabetic duration of 9.1 +/- 8.2 years. All of them underwent 24 hours ABPM. Intervals between measurements were 20 minutes at diurnal period and 30 minutes at nocturnal period. 28 patients [13.6%] only were at recommended target levels of blood pressure control [mean diurnal BP < 130/80 mmHg and nocturnal BP < 115/65 mmHg] and 137 patients were at the most bed control levels [mean diurnal BP ? 140/90 mmHg or nocturnal BP ? 125/75 mmHg]. Bed controlled patients had mildly higher waist circumference [p=0.08]. Poor BP control was associated with non dipper character [p<0.001], diabetic nephropathy [p<0.01] and diabetic retinopathy [p<0.01]. Our hypertensive treated diabetic patients were far from good blood pressure control. ABPM showed that the loss of nocturnal blood pressure fall was the most associated abnormality with poor BP control. Diabetic microangiopathy were more frequent in poor controlled patients

[Lack of association between renin-angiotensin system [RAS] polymorphisms and hypertension in Tunisian type 2 diabetics]

The genes encoding renin-angiotensin system [RAS] components are potent candidate genes in both hypertension and diabetes namely ACE encoding the angiotensin converting enzyme and AGT encoding angiotensinogen. It has been suggested that the insertion/deletion [I/D] polymorphism in intron 16 of ACE gene is associated with ACE levels, and M235T gene polymorphism is associated with plasma AGT levels. We examined in this report the association between ACE I/D and AGT M235T polymorphisms with hypertension status in Tunisian type 2 diabetic subjects. Thirty nine hypertensive and 22 normotensive type 2 diabetic Tunisian patients were recruited for this study. The I/D polymorphism of ACE gene was analysed with nested PCR in order to avoid mistyping heterozygous individuals and the M235T polymorphism of AGT gene was analysed using PCR and allele specific restriction. The distribution of DD, ID and II genotypes did not significantly differ between type 2 diabetic patients with or without hypertension [DD: 49%; ID: 41%; II: 10% vs DD: 36%; ID: 55%; II: 9%, respectively] [lasmbda[2]= .06, p=0.5 8]. There was also no significant statistical difference between these two groups for the M235T polymorphism [TT: 20%; MT: 54%; MM: 26% vs TT: 27%; MT: 41%; MM: 32%, respectively] lambda[2]=0.95, p=0.62] RAS polymorphisms do not seem to play a role in the development of hypertension in the studied Tunisian type 2 diabetic subjects

Current epidemiological, clinical and parasitological data concerning cutaneous lesishmaniasis in Tunisia

In order to update the geographical distribution of the three noso-geographical of cutaneous leishmaniasis [CL] occurring in Tunisia, namely the sporadic [SLCL zoonotic [ZCL] and chronic [CCL] forms, and to review their main pattern, a involving 244 cases, was carried out. Most of patients were infected in the Central and Southern parts of the country 74.2% and suffered of ZCL in 64.8% of cases. The three forms were registered in zones considered so far as preserved thus confirming their geographical spread. Sexes were equally affected [sex ratio: 1.02]. The patients were predominantly children and young] adults aged 24.6 years on average. ZCL lesions were mainly multiples [54.1%] localised in the limbs [81.5%] while those of SCL were rather isolated [91%, p<001] and affected the face [84.3%, p<0,00l]. Two clinical presentations prevailed: the classical ulcerous presentation with scabs in ZCL [72%] and the erythematous presentation in SCL [55,9%, p=0.002]. A negative correlation was found between the number and duration of the lesions on presentation [r=0, 22; p<0,00l]. The iso-enzymatic identification of 105 isolated strains confirmed that L. major was the most prevalent species [60.9%] followed by L. infantum [27.6%] and L. killicki [11.4%]. Within L. infantum complex, zymodeme MON-24 was prevailing [75,9%]. CL remains an emergent disease in Tunisia with an incidence and a geographicol spread continuously on the increase. Recent environmental changes, auspicious to Phlebotomine vectors and rodents reservoirs, had probably contributed to that situation

Donnees epidemiologiques; cliniques et parasitologiques actualisees de la leishmaniose cutanee en Tunisie

Afin d'actualiser la repartition geographique des 3 formes noso-geographiques de leishmaniose cutanee (LC) endemiques en Tunisie; la zoonotique (LCZ); la sporadique(LCS) et la chronique (LCC); et d'en rappeler certaines caracteristiques epidemiocliniques;une etude a concerne 244 cas de la maladie. La majorite des patients ont ete contamines au Centre et au Sud du pays (74;2) et correspondent a des cas de LCZ (64;8). Les 3 formes ont ete enregistres dans des regions considerees jusqu la indemnes traduisant leur extension geographique. Les 2 sexes ont ete egalement touches (sexe ratio=1;02). L'age moyen etait de 24;6 ans avec predominance d'enfants et d'adultes jeunes les lesions de LCZ etaient souvent multiples (54;1) et localisees aux membres (81;5) et celles de LCS plutot uniques (91; p0;001) touchant le visage (84;3; p0;001). Une orrelation negative a ete notee entre le nombre de lesions et leur anciennete (r) et celui en plaques erythemateuses infiltrees celles de LCS (55;9); p=0;002. Leishmania (L.) major se confirme l'espece la plus frequente (60;9). Au sein du complexe L. infantum (27;6); le zymodeme MON-24 a ete le plus identifie. L. killicki a represente 11;3des isolats. L'emergente de la LC se maintient en Tunisie avec une incidence elevee et une extension de la distribution geographique. Les changements environnementaux; a l'origine de bouleversements de la repartition et de la densite des phlebotomes vecteurs et des reservoirs respectifs; en seraient les principales cause

Surveillance des facteurs de risque des maladies cardiovasculaires en Tunisia: Methodologie et principaux resultats

To assess the Cardiovascular risk factors trend in a community based surveys. Method: Two population surveys were conducted in 1996-97 and 2000-01 in the Ariana region among 7608 adults 35-70 years aged. The surveys were based on: I- a questionnary, 2- an anthropometrical and physical examination, 3- a biological investigation, and 4 - an ECG registration for the second cohort. Relative to the first survey, the prevalence of hypertension, diabetes, hypercholesterolemia didn't change significantly while border line cholesterol increased on both genders, tobacco smoking decreased and ex-smokers increased on men. In both genders, hypertension and diabetes prevalence is low before 50 years but it increased after this age. Risk factors association is common: about 35% have more than two risk factors. This association is more common on women and diabetes-hypertension is the most frequent. These two surveys integrated in a global surveillance program has contributed to assess the CVDs burden and to identify priorities and intervention relevant to epidemiological region context

[For a better promotion of the breast-feeding]

Objective: Breast feeding has many advantages. Our objective is to determine influential factors on duration of exclusive breast feeding until 6 months of age and total breast feeding until 2 years

Methods: A retrospective transversal study was made on 271 mothers of children aged between 2 and 5 years. The objective of study was to determinate factors which influence duration of exclusive and total breastfeeding. Epi-info was used to size and to analyse results, odds ratio and confiding intervals were calculated. Logistic regression method was also used

Results and Comments: Duration of exclusive breastfeeding was longer when mother instruction was less than higher school [3,4 months versus 2,9 months, p <0,01], if there were not any maternal complications on breastfeeding period [4,3 months versus 3,1 months, p < 0,001]. Duration of total breast feeding was longer when cow milk was introduced later and child sucking was important [more than 6 times a day]. There was no correlation between weight and length of children and duration of breastfeeding

Conclusion: We recommend promotion of breastfeeding

[Risk factors of leishmanin-skin test positivity in transmission of Leishmania infantum in the center of Tunisia]

This work aims to estimate prevalence and evaluate risk factors of leishmanin-skin test positivity. A cross-sectional leishmanin skin test study was carried out on a sample of 3190 healthy volunteers living in the gouvernorates of Kairouan and Kasserine. Age standardized prevalence of leishmanin-skin test positivity was 45.9% [CI95% = [43.9-47.9]] confirming the hyper endemicity of this region. The rate of leishmanin-skin test positivity ranged from 75.9% [CI95% = [71.9-79.5]] in Zaghdoud [Kairouan] to 6.5% [CI95% = [3.7-11.01] in Abdeladhim [Kasserine]. There is no significant difference between men and women suggesting a similar exposure to infection. In the districts of Zaghdoud, Sidi Amor, El Hajeb and chbika, age specific rates showed a rapid increasing positive prevalence with age reaching a proportion exceeding 80% after the age of 15 years. However, the age specific prevalence from other delegations showed a progressive increasing trend with age, with a low rate for younger children and a plateau of 75% after 45 years. Multivariate analysis of leishmanin-skin test positivity risk factors showed that only district and age are determinants of this infection

[Study of incidence of nosocomial infection in a general surgery service]

Nosocomiol infection incidence and its cost were studied. We have identified 61 infected patients and 75 infectious episodes, is an incidence of 9,4% infected for 100 hospitalized by trimester. Operative site infections are the most frequent [60%], operative site infection [9,1%], inferior respiratory ways infections [2,2%]. Incriminated germs are represented essentially by negative gram Bacillus [77,3%] with predominance of enterobacterias [59%]. Invasive technique usage, surgery types and contamination classes have been identified as risk factors of nosocomial infection occurrence. The supplementary stay duration estimated by simple comparison between infected group and non-infected one is 9,3% days, responsible of an over cost of 336 TD by infected patient and 273 TD by infectious episode. The curative antibiotic costs have been estimated at 70 TD by infected patient being equivalent to two hospitalization days and to 57 TD by infectious episode

[Death cause declaration in Tunisia]

We have led a study about 2251 death which are declared during 1996 in the Great-Tunis. Results are following :The hospital deaths are as many betters certified that the physician is a specialist. The cause mention rate is about 88,6% for death observed by specialists against 28,5% for those observed by internists. Paradoxically, a precise cause mention is best for deaths that are observed outside hospitals and when the physician is an internist. Badly define morbid states represent 17,1% of outside hospitals mentioned causes against 30,8% in the Hospital. They represent 12% of causes mentioned by internist against 30,1% of those mentioned by specialists. Despite death medical certificate obligation, the strong proportion of badly defined morbid states characterizes death causes. We hope that this situation will be improved by the new model usage of the which will be introduced since 2000. This certificate mentions death causes distinguished in initial, immediate and associated. This certificate has be the object of the decree n° 99 - 1043 of 17 May 1999