Investigation of a human brucellosis outbreak in Douz, Tunisia, 2018.

OBJECTIVES: In 2017, the incidence of human brucellosis in Tunisia was 9.8 per 100,000 population. In the Douz district, 2 cases were reported in March 2018. Prior to that date, the last indigenous cases to be reported in Douz had been in 2015. This study aimed to identify the source of this new contamination and recommend control interventions. METHODS: This case-control study included residents of Douz who presented with clinical symptoms of brucellosis and had a subsequent Wright test antibody titer ≥ 1/160. The controls were neighbors of the infected cases who had a negative Rose Bengal test. Univariate and multivariate analyses were performed to estimate the odds ratios of risk factors. Goats belonging to the cases and controls were actively screened. RESULTS: Twenty-five infected cases and 52 uninfected controls were enrolled. All infected cases had consumed goat milk and 92% had purchased it from the same breeder. Consumption of goat milk from this breeder (adjusted odds ratio [aOR], 30.78; 95% confidence interval [CI], 6.47 to 235.91) and overall consumption of raw goat milk (aOR, 14.84; 95% CI, 2.04 to 310.44) were independent risk factors for brucellosis. The breeder had 18 goats, 5 of which were smuggled from a neighboring country. Three of those goats were diagnosed with brucellosis. CONCLUSIONS: Consumption of raw milk from smuggled sick goats was the main risk factor in this outbreak. The sick goats were slaughtered and an education campaign was conducted. Vaccination, control of cross-border animal movements, and control of goat milk sales must be strengthened to prevent the spread of brucellosis in southwestern Tunisia.

The scorpion envenomation in the region of Faouar-KEBILI at 2010-2012 : study of 421 cases.

BACKGROUND: The scorpion envenomation is a problem of public health in Tunisia by its incidence and severity. AIM: The aim of this study is to evaluate the epidemiology of scorpion envenomation in health unit of Faouar, as well as promoting the prevention and fight against scorpion envenomation. METHODS: In this study, we conducted a retrospective and descriptive analysis of scorpion envenomation cases admitted to the emergency department of the local hospital Faouar between 2010 and 2012. RESULTS: In Total 421 cases were registered (237 men and 184 women) with no age predilection. The accident often occurs during the warm months of the year. So most of the cases were recorded from May to September with a frequency peak in July (21.1% of cases). The outcome was favorable in 92% of cases due to early consultation, a time management of less than 60 minutes in most cases (87%), and a fast and adequate care according to the national protocol issued by the Ministry of Public Health. CONCLUSION: Prevention and education, especially in endemic period still remain indispensable in the fight against scorpion envenomation.

[Factors of cardiovascular risk for hypertensive patients followed during primary care]. / Composantes du risque cardiovasculaire chez les patients hypertendus suivis en première ligne (Sousse, Tunisie).

AIM: To describe the elements of cardiovascular risk in order to calculate global cardiovascular risk in primary care hypertensive patients in Sousse Tunisia. METHODS: Cross sectional study including 456 hypertensive patients followed in 7 public health centers. Cardiovascular risk was assessed according the World Health Organization/International health society recommendations. RESULTS: Average age was 65.6 +/- 9.8 years, Sex Ratio was 0.18. Sixth of the patients had at least three risk factors, the most frequent of them were getting advanced in years, mild hypertension and diabetes mellitus. Targer organ damages was showed in 13.8%; 8.3% presented an associated cardiovascular diseases. Cardiovascular risk was very high in about 20% of patients. CONCLUSION: Primary care hypertensive patients show a heterogeneous cardiovascular risk. Patients with very high risk should be referred to specialists in order to benefit by a better care.

[Audit of management of arterial hypertension in primary health care in Sousse]. / Audit de la prise en charge de l'hypertension arterielle dans les structures de sante de premiere ligne a Sousse.

A medical audit has been carried out on a representative sample of 456 hypertensive patients followed in the health care facilities of Sousse during 2002, to evaluate the quality of management of hypertension in primary health care. The study yielded the following results: the patients selected for a first line follow-up did not represent more than 79% of the studied population. The minimal recommended balance was achieved in 8% of cases only. Adequate drug therapy was prescribed in 64% of cases. 59% of patients were considered compliant. Controls of blood pressure was achieved in 5,5% of patients. The quality of management of hypertension in primary health care was considered satis factory in 28,7% of patents with a significant difference between urban and rural areas (24,9% versus 40,5%). These results indicate that increased attention should be paid by the national program of Struggle against the Chronic Diseases to the quality of management of hypertension in primary health care institutions.