[Lineage assignment in acute leukemia: confrontation between cytology and immunophenotyping]. / Diagnostic de lignée dans les leucémies aiguës : confrontation entre cytologie et immunophénotypage.

OBJECTIVE: The determination of the cellular lineage in acute leukemia is a crucial step in the diagnosis and the later therapeutic conduct. In Tunisia, emerging country, some cases of acute leukemias are still treated on the basis of an only cytologic study because of lack of cytometry. Our objective is to realize a confrontation between cytology and flow cytometry in the diagnosis of AL and to analyze discrepancies. PATIENTS AND METHODS: The study concerns 100 cases of AL. A second double-blind examination of the bone marrow smears of acute leukemias is realized by two cytologists and confronted to immunophenotyping. RESULTS: In two cases of AML, flow cytometry reassigned lineage into T ALL and biphenotypic AL. In three cases of ALL the lineage was reassigned into undifferentiated acute leukemia (2 cases) and biphenotypic acute leukemia (1 case). Lineage was not established in four cases, immunophenotyping allowed the diagnosis of B ALL in 3 cases, and of biphenotypic acute leukemia in 1 case. In both cases of discrepant findings, flow cytometry allowed the diagnosis of biphenotypic acute leukemia in a case and of AML in the other one. CONCLUSION: The cytological study remains insufficient in the diagnosis of lineage even with experimented cytologists. Immunophenotyping is essential in lineage assignment and reassignment.

[Causes of death in Tunisia: estimates of years of life lost]. / Causes de décès en Tunisie : estimation des années de vie perdues.

This study estimated the number of years of life lost (YLL) by cause due to premature death in Tunisia for the year 2006. We adopted the methodology (SEYLL) proposed by Murray and Lopez. The crude rate of YLL was 58.1 per 1000 inhabitants. After age-standardization using the world population, we obtained a rate of 57.7 YLL per 1000. Cardiovascular diseases (CVD) (19.3% of total YLL) and cancers (17.8%) dominated the burden of premature mortality, followed by perinatal conditions (13.6%). Excluding extreme age groups where perinatal conditions (0-4 years) and CVD (> 60 years) dominated the YLL's causes, injuries (road traffic crashes, falls, etc.) and cancers were most responsible for YLL. The present study highlights the major contribution of noncommunicable diseases to YLL in Tunisia. The promotion of healthy lifestyle and the reinforcement of secondary prevention in primary health care are the best ways to tackle these diseases.

[Causes of death in Tunisia: estimates of years of life lost]

This study estimated the number of years of life lost [YLL]by cause due to premature death in Tunisia for the year 2006.We adopted the methodology [SEYLL]proposed by Murray and Lopez.The crude rate of YLL was 58.1 per 1000 inhabitants.After age-standardization using the world population, we obtained a rate of 57.7 YLL per 1000.Cardiovascular diseases [CVD][19.3% of total YLL]and cancers [17.8%]dominated the burden of premature mortality, followed by perinatal conditions [13.6%]. Excluding extreme age groups where perinatal conditions [0-4 years]and CVD [>60 years]dominated the YLL's causes, injuries [road traffic crashes, falls, etc.] and cancers were most responsible for YLL.The present study highlights the major contribution of noncommunicable diseases to YLL in Tunisia.The promotion of healthy lifestyle and the reinforcement of secondary prevention in primary health care are the best ways to tackle these diseases

قام الباحثون في هذه الدراسة بتقدير عدد سنوات الحياة المفقودة نتيجة الموت المبكر، موزعة حسب أسباب الوفيات في تونس في عام 2006 . وقد اتبع الباحثون الطريقة المعيارية لحساب سنوات الحياة المتوقع فقدانها وهي الطريقة التي ابتكرها موري ولوبيز. ووجدوا أن المعدل الخام لسنوات الحياة المفقودة هو 58.1 لكل ألف نسمة، وبعد إضفاء المعيارية بالنسبة للسن بالاعتماد على عدد سكان العالم، حصل الباحثون على معدل 57.7 لسنوات الحياة المفقودة لكل ألف نسمة. وقد غلبت على عبء الوفيات المبكرة كل من أمراض القلب والأوعية [19.3 % من مجمل سنوات الحياة المفقودة]والسرطانات [17.8 %]، وتلاهما وفيات حالات الخداج والحالات المحيطة بالولادة [13.6 %]. وعندما استبعد الباحثون المجموعات العمرية القاصية التي تغلب فيها الحالات المحيطة بالولادة [0 - 4 سنوات]والأمراض القلبية الوعائية [في الأعمار أكثر من 60 عاما]، وجدوا أن الأسباب الغالبة لسنوات الحياة المفقودة هي الإصابات [حوادث التصادم على الطرق والسقوط وغير ذلك]، والسرطانات، فهي الأكثر مسؤولية عن سنوات الحياة المفقودة. وتوضح هذه الدراسة الإسهام الكبير للأمراض غير السارية في سنوات الحياة المفقودة في تونس. ولعل أفضل الطرق للتصدي لهذه الأمراض هي تعزيز الحياة الصحية وتعزيز الوقاية الثانوية في الرعاية الصحية الأولية

Cette étude présente une estimation des années de vie perdues [AVP]du fait d'un décès prématuré, par cause, en Tunisie pour l'année 2006.Nous avons adopté la méthodologie SEYLL [Standard Expected Years of Life Lost]proposée par Murray et Lopez.Le taux brut d'AVP était de 58, 1 pour 1000 habitants; celui standardisé sur la population mondiale était de 57, 7 pour 1000.Les maladies cardio-vasculaires [19, 3 %]et les cancers [17, 8 %]étaient les plus pourvoyeurs d'AVP, suivis par les affections périnatales [13, 6 %]. En dehors des classes d'âge extrêmes prédominées par les affections périnatales [0-4 ans]et les maladies cardio-vasculaires [>60 ans], c'étaient les cancers et les traumatismes [accidents de la circulation, chutes, etc.] qui étaient les plus pout-voyeurs d'AVP.L'étude souligne la part majeure des maladies non transmissibles dans les pertes en années de vie en Tunisie.La promotion d'un mode de vie sain et la prévention secondaire en première ligne semblent les moyens de lutte les plus efficaces contre ces maladies

[Medical knowledge in immunological security of red blood cells transfusion in Tunisia: evaluation of a CD-ROM of auto-learning]. / Connaissances médicales en matière de sécurité immunologique en transfusion érythrocytaire en Tunisie : évaluation d'un CD-ROM d'auto-enseignement.

In Tunisia, red blood cells (RBC) transfusion joins in a statutory frame but remains subject to failures because of the misunderstanding of legislation and regulations. Our purpose is to estimate the knowledge of the medical staff in the immunological safety of RBC transfusion before and after reading an auto-education CD-ROM. It is a study of evaluation of an intervention. Eighty physicians participated to the study. The evaluation was done using an anonymous questionnaire, containing seven questions with multiple choices (QMC) relating to several items. The rate of good answers (RGA) calculated by questions and by items took into account the impact of the CD-ROM on the improvement of the answers after reading. The global average mark is 2.9/7. The RGA to questions varies from 22.5 % to 76.3%. All participants answered correctly to more than 50% of all items. Two answered correctly to all items. Among the participants, 31.3% answered to all "important" items, concerning ABO blood groups compatibility and ultimate bedside test. The rate of participation to the final evaluation was 83%. The impact of the CD-ROM was important and statistically significant. In the final evaluation, the global mark raised from 2.9 to 5.8/7, 31.5% (vs 2%) answered correctly all the questions and 95.5% (vs 31.3%) answered correctly all "important" items. This study revealed a misunderstanding of the doctors in immunological safety of RBC transfusions. Auto-teaching by CD-ROM was efficient. An improvement of the knowledge by continuous training is necessary in our country.

Y402H polymorphism in complement factor H and age-related macular degeneration in the Tunisian population.

To evaluate a possible association between the complement factor H (CFH) Y402H polymorphism and susceptibility to age-related macular degeneration (AMD) in the Tunisian population, as well as the impact of the genotype distribution among different phenotypes and the response to treatment with intravitreal bevacizumab, exon 9 of CFH was analyzed for the Y402H polymorphism by direct sequencing in 135 healthy controls and 127 sporadic unrelated AMD patients classified into the following groups: 12 atrophic AMD (group G1), 115 exudative AMD (G2) and 10 AMD patients who had fibrovascular scarring (G3) that did not allow a precise grading of the phenotype. Seventy patients in G2 were treated with 1.25 mg intravitreal bevacizumab at 6-week intervals until choroidal neovascularization (CNV) was no longer active. The frequency of the CFH 402H allele was significantly higher in AMD patients than in controls (p = 2.62 × 10(-16)). However, subgroup analysis does not reveal any association between the variant allele H and phenotypes of AMD or CNV. Also, there was no significant difference in response to bevacizumab treatment according to Y402H CFH genotype (p = 0.59). A strong association of the 402H allele with susceptibility to AMD in the Tunisian population was confirmed; however, this variant does not appear to be involved in the clinical progression of this disease or in the postintravitreal bevacizumab response.

[Reasons for using emergency departments of major hospitals in Greater Tunis]. / Motifs du recours aux services d'urgence des principaux hôpitaux du Grand Tunis.

Tunisia, similar to many countries, has a problem of overcrowding of the emergency departments (ED). This study aimed to analyse the reasons for using EDs, and to describe the seriousness of the attendees' condition and their itinerary before their arrival at ED. This cross-sectional study in 2009 was conducted in ED of 4 hospitals in GreaterTunis and targeted 1058 patients of both sexes, aged 18 years, with stratification according to time of day of presentation to ED (morning, afternoon and evening). Information was recorded on the sociodemographic characteristics of the study participants, reasons for choosing ED, time of and reason for consultation, diagnosis and severity of illness. Over half the patients (52.5%) were male and the mean age was 46.0 (SD 18.1) years. The main reasons for choosing the ED were: speed (54.0%) and ease of access (47.7%) of ER and occurrence of an acute episode (26.4%). Patients with serious illness accounted for only 6.3% of those interviewed. Implementation of good practices and better coordination between public and private services and the ED are needed to reduce unnecessary visits to ED.

Reasons for using emergency departments of major hospitals in Greater Tunis

Tunisia, similar to many countries, has a problem of overcrowd ing of the emergency departments [ED]. This study aimed to analyse the reasons for using EDs, and to describe the seriousness of the attendees' condition and their itinerary before their arrival at ED. This cross-sectional study in 2009 was conducted in ED of 4 hospitals in GreaterTunis and targeted 1058 patients of both sexes, aged >/= 18 years, with stratification according to time of day of presentation to ED [morning, afternoon and evening]. Information was recorded on the sociodemographic characteristics of the study participants, reasons for choosing ED, time of and reason for consultation, diagnosis and severity of illness. Over half the patients [52.5%] were male and the mean age was 46.0 [SD 18.1] years. The main reasons for choosing the ED were: speed [54.0%] and ease of access [47.7%] of ER and occurrence of an acute episode [26.4%], Patients with serious illness accounted for only 6.3% of those interviewed. Implementation of good practices and better coordination between public and private services and the ED are needed to reduce unnecessary visits to ED

Soluble human leukocyte antigen-G (SHLA-G) in Tunisian kidney transplantation.

To investigate the relationship between the soluble HLA-G (sHLA-G) and the appearance of acute renal rejection (AR) episodes we have quantify in this study the level of sHLA-G by enzyme-linked immunosotrbent assay in 42 kidney transplant patients classified in two groups: G1: 17patients with acute rejection (AR+) and G2: 25 patients without AR (AR-). To establish our normal sHLA-G ranges, serum samples from 18 healthy controls were tested. Pre-transplantation sHLA-G levels were significantly increased in patients (mean +/- standard error of the mean, 60.48 +/- 12.18 units/ml) than healthy subjects (19.11 +/- 4.9 units/ml) (p = 0.001). Although the difference was not statistically significant, G1 patients (AR+) revealed lower levels of sHLA-G (mean +/- standard error of the mean, 31.25 +/- 6.71 units/ml) compared to G2 patients (AR-) (53.43 +/- 1721 units/ml). Nevertheless, the course of total sHLA-G levels was nearly identical in patients with and without rejection. Nonparametric analysis revealed that pre-transplantation levels of sHLA-G < 18.00 units/ ml (sensitivity: 87.8% and specificity of 72.2%) were not related to rejection. Also, multivariate analysis regarding anti-HLA antibody status, recipient age and gender showed that sHLA-G could not be an independent risk factor for renal graft rejection. However, a higher sera levels of sHLA-G seemed to contribute to better kidney allograft survival rate after 10 years of follow-up (significance tendency: p = 0.091) as shown by the survival analysis. Because of the small number of subjects studied, these results must be treated with caution. A much larger cohort of kidney transplant patients according to acute rejection would seem necessary to confirm these findings.

Association of chemokine and chemokine receptor polymorphisms with activity degree of IBD in Tunisian patients.

Crohn's disease (CD) and ulcerative colitis (UC) have complex genetic background that is characterised by more than one susceptibility locus. To detect a possible association between the functional polymorphisms of the chemokine receptors CCR5, CCR2 and MCP-1 genes and susceptibility to CD and UC in Tunisian population, polymorphisms of CCR5-delta32, CCR5-59029-A/G, CCR2-V641 and MCP-1-2518-G/A were analysed in 194 Inflammatory bowel disease (IBD) patients and 169 healthy blood donors using PCR-RFLP and PCR-SSP methods. The patients were classified in 126 patients with CD and 68 patients with UC. The genotypic and allelic frequencies of all polymorphisms studied, did not reveal significant differences between patients and conrols and among CD and UC patients. However, analysis of CD patients revealed that those without homozygosous G/G genotype are more frequently in remission compared to those with this genotype (OR: 0.4, 95% CI: [0.174-0.928]; p = 0.03). Also, the frequency of the CCR2-641 muted allele was statistically higher in CD patients in remission disease than those in active form (OR: 0.267 95% CI: [0.09-0.78]; p = 0.01). Adjustment for known covariates factors (age, gender and immunosuppressive regimen) confirmed these univariate findings and revealed that the CCR5-59029-A/G and CCR2-V64I genotype were associated to remission form of CD (OR: 263; 95% CI: [1.01-6.80]; p = 0.047 and OR: 4.64; 95% CI: [1.01-21.31]; p = 0.049 respectively). In conclusion, the present study supports the involvement of chemokine receptor (CCR2 and CCR5) polymorphisms in activity degree of the IBD disease in Tunisian patients.

[Cost effectiveness analysis of screening strategies for cervical cancer in Tunisia]. / Analyse coût-efficacité des stratégies de dépistage du cancer du col utérin en Tunisie.

We aimed to identify the most appropriate screening strategy for cervical cancer (periodicity of 3, 5 or 10 years) for Tunisia, taking into consideration the incidence of the disease, costs of screening and economic implications. We simulated follow-up of a fictitious cohort of 1 million women 35-39 years over 30 years. Computation of yearly medical care costs was based on data from medical files of patients diagnosed with cervical cancer in 2004 at the National Institute of Cancer, Tunis. For a 60% coverage level of screening, cervical cancer reduction would be 49.2% for a 3-year periodicity. The reduction would be 40.3% and 33.1% for 5 and 10 years periodicity respectively. Considering cost-effectiveness, 10-year screening gave the lowest annual cost to avoid 1 cervical cancer case.

[Cost-effectiveness analysis of screening strategies for cervical cancer in Tunisia]

We aimed to identify the most appropriate screening strategy for cervical cancer [periodicity of 3, 5 or 10 years] for Tunisia, taking into consideration the incidence of the disease, costs of screening and economic implications. We simulated follow-up of a fictitious cohort of 1 million women 35-39 years over 30 years. Computation of yearly medical care costs was based on data from medical files of patients diagnosed with cervical cancer in 2004 at the National Institute of Cancer, Tunis. For a 60% coverage level of screening, cervical cancer reduction would be 49.2% for a 3-year periodicity. The reduction would be 40.3% and 33.1% for 5 and 10 years periodicity respectively. Considering cost-effectiveness, 10-year screening gave the lowest annual cost to avoid 1 cervical cancer case

[Neurological abnormalities in xeroderma pigmentosum]. / Les atteintes neurologiques au cours du xeroderma pigmentosum.

INTRODUCTION: Xeroderma pigmentosum (XP) is an autosomal recessive disease characterized by abnormal sensitivity to sunlight which results in pigmentary changes, telangiectases, keratoses and eventually carcinomata. Additional neurological complications can be associated. The aim of our study was to analyze particularities of neurological abnormalities of Tunisian patients. METHOD: We conducted a retrospective study in 62 patients suffering from XP included during the period 1992-2007. Patients were aged from 1 to 64 years (mean age: 17.6 +/- 11.4 years). Thirty patients were female and 32 were male. The patients had severe (n=16), variant (n=15) and moderate (n=31) XP. RESULTS: Neurological abnormalities were observed in 21 patients (33.9%). Mental retardation was observed in 15 of the 21 patients, pyramidal syndrome in five, cerebellar syndrome in two, extrapyramidal syndrome in two, microcephalia in two, choreoatetosis in three cases and a peripheral neuropathy in eight. No neurological disorder was observed in the XP-variant patients. Neurological abnormalities were more frequent in the patients with moderate XP (n=17, 64.5%) than with severe XP (p=0.051). CONCLUSION: This difference in a group of Tunisian patients confirms the heterogeneous nature of XP and is probably due to genetic heterogeneity.

Health and behaviours of Tunisian school youth in an era of rapid epidemiological transition.

To assess youth health behaviours and related quality of life in urban Tunisia, we conducted a cross-sectional survey of a representative sample of 699 secondary-school students. The overweight rate was 20.7%. Most of the sample had an insufficient level of physical activity and were unfamiliar with the recommended frequency of moderate physical activity. Norm-based scores of psychological state were about average, slightly better for boys than girls. Girls perceived themselves to be more stressed than boys. Of all students, 35% declared having smoked a cigarette and 14% having drunk alcohol at least once in their lives. The main sources of health education were mass media (59%) and medical staff (36%).

Health and behaviours of Tunisian school youth in an era of rapid epidemiological transition

To assess youth health behaviours and related quality of life in urban Tunisia, we conducted a cross-sectional survey of a representative sample of 699 secondary-school students. The overweight rate was 20.7%. Most of the sample had an insufficient level of physical activity and were unfamiliar with the recommended frequency of moderate physical activity. Norm-based scores of psychological state were about average, slightly better for boys than girls. Girls perceived themselves to be more stressed than boys. Of all students, 35% declared having smoked a cigarette and 14% having drunk alcohol at least once in their lives. The main sources of health education were mass media [59%] and medical staff [36%]

[Management of acute myocardial infarction: the experience of a Tunisian hospital]. / Prise en charge therapeutique de l'infarctus du myocarde a la phase aigue: Expérience d'un hôpital de Tunis.

UNLABELLED: The aim of this work was to study some aspects of the management of acute myocardial infarction. MATERIAL AND METHODS: Data concerning 153 patients had been collected during one year between July 1st, 2000 and June 30, 2001 from patients' databases. RESULTS: Our population was constituted of 126 men (82.4%) and 27 women (17.6%). The average age was 61 years. 101 patients (66.0%) were treated by thrombolysis with an average delay of 5.3 +/- 2.8 hours. Streptokinase was the thrombolytic agent used in all cases. Percutaneous transluminal coronary angioplasty was performed in thirteen patients (8.5%) (5 primary angioplasties, 4 rescue angioplasties and 4 programmed angioplasties). Stents were implanted in 12 patients. A cardiac surgery was performed in three patients (2 coronary artery bypass graft surgery and 1 closure of ventricular septal defect) in acute phase of their myocardial infarction. The global rate of revascularisation was 71%. CONCLUSION: The thrombolytic therapy remains the most used means of revascularisation in our country because it is available and not expensive. The use of coronary angioplasty in emergency remains exceptional because the technical means were insufficient.