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

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

[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