Congenital anomalies in Tunisia: Frequency and risk factors.

BACKGROUND: Despite the high risk of recurrence of congenital malformations, there are no well-accepted preventive measures in developing countries like Tunisia. It is recommended that thorough epidemiological studies of congenital anomalies in this country are needed. The aim of this study is to assess the frequency and types of congenital anomalies in Tunisia and research some risk factors associated with occurrence of these anomalies. METHODS: In this retrospective study, all the fetuses who were autopsied during 21years period from February 1991 to December 2011 (n=9678) at Service of embryofetopathology in the Center of Maternity and Neonatology of Tunis (CMNT) were studied. The classification of malformations was based upon the anatomical system affected. The differences in fetal/maternal characteristics between cases with or without congenital malformations were assessed using Chi2 test. RESULTS: Of the all 9678 autopsied fetuses, 4498 (46.47%) were diagnosed as being malformed fetuses. Anomalies of limbs (22.71%) and digestive and abdominal wall defects (14.76%) were mostly detected, followed by congenital brain defects (13.41%) and nephrourologic abnormalities (11.23%). A marked association of parental consanguinity with increased congenital anomalies rates was found (P<10-6, OR=1.89, CI=1.69-2.13). CONCLUSION: In Tunisia, surveillance and epidemiological evaluation of congenital anomalies underline the high frequency of these events. This will help to better target congenital anomalies prevention and screening policies in our population.

[Evaluation of the role of dietary intake in the occurrence of alopecia]. / Evaluation du rôle des apports alimentaires dans la survenue d'une alopécie diffuse.

Transversal case-control study was conducted among 42 patients aged between 20 and 35 years who had diffuse alopecia. Alimentary inquiry according to the 3-day method was achieved in each case. The following nutriments were evaluated: total proteins, calcium, copper, iron, iodine, magnesium, manganese, phosphorus, potassium, selenium, zinc, omega 3 and omega 6. A control group (composed of 230 individuals), matched for age, gender and metabolic profile was established. These persons did not suffer from hair and nail disorder. The nutriments were codified according to the data of the software Food processor 8.3 version. The data were analyzed using "SPSS" 11.5 version. Comparisons of the means were performed using the Student's t test. ROC graphics allowed to determine the statistically significative limits for the comparison of both groups. On multivariate analysis, only a protein intake was directly associated to alopecia, odds ratio of 1,5 (1,06 - 2,3) p=0,02.

Waist circumference cut-off points for identification of abdominal obesity among the tunisian adult population.

AIMS: Waist circumference (WC) is a convenient measure of abdominal adipose tissue. It itself is a cardiovascular disease (CVD) and diabetes-risk factor and is strongly linked to other CVD risk factors. There are, however, ethnic differences in the relationship of WC to the other risk factors. The aim of this study was to determine the optimal cut-off points of WC and body mass index (BMI) at which cardiovascular risk factors can be identified with maximum sensitivity and specificity in a representative sample of the Tunisian adult population and to investigate any correlation between WC and BMI. METHODS: We used a sample of the Tunisian National Nutrition Survey, a cross-sectional population-based survey, conducted in 1996 on a large nationally representative sample, which included 3435 adults (1244 men and 2191 women) of 20 years or older. WC, BMI, blood pressure and fasting blood measurements (plasma glucose, total cholesterol, triglycerides) were recorded. Receiver operating characteristic (ROC) curve analysis was used to identify optimal cut-off values of WC and BMI to identify with maximum sensitivity and specificity the detection of high blood pressure, hyperglycaemia, high blood cholesterol and hypertriglyceridaemia. RESULTS: ROC curve analysis suggested WC cut-off points of 85 cm in men and 85 cm in women for the optimum detection of high blood pressure, diabetes and dyslipidaemia. The optimum BMI cut-off points for predicting cardiovascular risk factors were 24 kg/m(2) in men and 27 kg/m(2) in women. The cut-off points recommended for the Caucasian population differ from those appropriate for the Tunisian population. The data show a continuous increase in odds ratios of each cardiovascular risk factor, with increasing level of WC and BMI. WC exceeding 85 cm in men and 79 cm in women correctly identified subjects with a BMI of >/=25 kg/m(2), sensitivity of >90% and specificity of >83%. CONCLUSIONS: Based on the ROC analysis, we suggest a WC of 85 cm for both men and women as appropriate cut-off points to identify central obesity for the purposes of CVD and diabetes-risk detection among Tunisians. WCs of 85 cm in men and 79 cm in women were the most sensitive and specific to identify most subjects with a BMI >/=25 kg/m(2).

The global diabetes pandemic: the Tunisian experience.

OBJECTIVE: The prevalence of diabetes mellitus is known to be increasing rapidly worldwide, but few population-based surveys have been undertaken in Africa or the Middle East. The aims of this study are to report the prevalence of diabetes mellitus and impaired fasting glucose (IFG) in Tunisia, to compare the prevalence to previous studies and to analyse the relationship between diabetes and age, sex, area of residency and body mass index (BMI). SUBJECTS AND SETTING: We have used data from the Tunisian National Nutrition Survey, a cross-sectional health study providing a large nationally representative sample of the Tunisian population including 3729 adults. We used the American Diabetes Association diagnostic criteria to determine the prevalence of diabetes mellitus and IFG. RESULTS: The overall diabetes prevalence was 9.9% (9.5% in men and 10.1 in women) giving age-adjusted prevalence of diabetes of 8.5% (7.3% in men and 9.6% in women). Step-wise logistic regression showed age of more than 40 years, urban residency and high BMI to each be significantly and independently related to diabetes prevalence. The prevalence of diabetes mellitus has more than doubled in Tunisia over a 15-year period. CONCLUSIONS: Our study has demonstrated a high prevalence of diabetes in the adult population with a wide difference among the rural and urban areas with an increased prevalence compared to previous studies. The results underline the need to increase public awareness and to emphasize the benefit of lifestyle modification in order to prevent type II diabetes.

Prevalence of metabolic abnormalities in the Tunisian adults: a population based study.

AIMS: To estimate the prevalence of individual metabolic abnormalities and the cluster of metabolic abnormalities in a representative sample of the Tunisian adult population and to identify their relationship with gender, age and residency. The definition used is an adaptation of the NCEP ATP III definition, using total cholesterol>or=5.2 mmol/l instead of HDL-cholesterol. MATERIALS AND METHODS: We used a sample of the Tunisian National Nutrition Survey (TNNS), a cross-sectional health survey conducted in 1996, to estimate the nutritional status of the population. The TNNS included 2 927 adults aged 20 years or older who had measurements of height, body weight, waist circumference, blood pressure, fasting plasma glucose, total cholesterol and triglycerides. The cluster of metabolic abnormalities was defined as the presence of three or more metabolic abnormalities. RESULTS: The prevalence of abdominal obesity, hypertriglyceridemia, high total cholesterol, high blood pressure and high fasting plasma glucose was, respectively, 9%, 23%, 24%, 45% and 15% in men and 33%, 19%, 29%, 44% and 15% in women. The prevalence of the cluster was more frequent in women than in men (18% versus 13%, P<0.001) and in those living in urban communities (21% in women, 16% in men) rather than rural communities (11% in women, 8% in men) (P<0.001). The prevalence also increased significantly with age (P<0.001). CONCLUSION: The cluster of metabolic abnormalities and its components are common in the Tunisian adult population and prevalence increases significantly with female sex, urban residency and age.

[Association study between diabetic retinopathy and aldose reductase gene polymorphism in Tunisians]. / Etude de l'association entre la rétinopathie diabétique et un polymorphisme du gène de l'aldose réductase dans la population tunisienne.

INTRODUCTION: Aldose reductase (ALR2), the enzyme of the polyol pathway, may play an important role in the pathogenesis of diabetic microvascular complications, namely diabetic retinopathy. The study aimed to determine whether the aldose reductase gene is involved in diabetic retinopathy in the Tunisian population. MATERIAL: and methods: A case-control study was conducted in 47 type 2 diabetic patients who have diabetic retinopathy and 28 diabetic patients without diabetic retinopathy in spite of diabetes lasting for more than 5 years and over 10 years in 13 cases. We investigated the association between the (CA)n polymorphism located at 2.1 kb upstream of the transcription start site of ALR2 and diabetic retinopathy. The distribution of genotypes and alleles was compared between cases and controls by chi2 test using Epi info software. RESULTS: Genotyping of the two groups did not demonstrate any association between the alleles of this marker and diabetic retinopathy in the Tunisian population studied. DISCUSSION: An association between one of the alleles (Z - 2) of this microsatellite and diabetic retinopathy was identified in Chinese and Japanese patients with type 2 diabetes. Discordant results were obtained for the different populations studied. The lack of an association between diabetic retinopathy and ALR2 alleles indicates that the ALR2 gene is not a genetic marker of predisposition to diabetic retinopathy for type 2 diabetic patients in the Tunisian population studied.

[Diabetic retinopathy in insulin-dependent diabetes mellitus at time of diagnosis]. / Rétinopathie diabétique concomitante du diagnostic de diabète de type I.

Diabetic retinopathy is one of the diabetic microangiopathy complications generally occurring after insulin-dependent diabetes has evolved for a few years. We report a 27-year-old woman with severe nonproliferative diabetic retinopathy discovered at the time of insulin-dependent diabetes diagnosis. Argon laser photocoagulation of retinal ischemic territories was initiated. The disease progressed to proliferative diabetic retinopathy. Diabetic retinopathy incidence, onset and severity in insulin-dependent diabetics is discussed. Systematic ophthalmic examination seems necessary at the onset of insulin-dependent or non-insulin-dependent diabetes.

[Medical termination of pregnancy. Indications, techniques and complications. Report of 55 cases]. / Les interruptions medicales de grossesse (IMG). Indications, techniques et complications. A propos de 55 cas.

We tried through this study to reassemble the cases of medical termination of pregnancy for foetal or maternal anomalies and analyse the epidemiological characteristics of our population and the procedures of induction of labour. We report a retrospective study about 55 cases of medical termination of pregnancy during 20 months indexed in service "C" of the centre of maternity and neonalogy in collaboration with the service of fetopathology. 12.73% of our patients were older than 38 years. The incidence of medical termination of pregnancy during the same period was about 1.90 cases/100 deliveries. Maternal indications was reported in 34.55% of cases and neurological malformations dominate the foetal anomalies (47.22%). Extra-amniotic saline infusion was used in 52.72% of cases and was responsible of all the complications observed (16.36%).

[Diagnosis of holoprosencephalia. Report of 17 cases]. / Diagnostic de l'holoprosencephalie. A propos de 17 cas.

OBJECTIVE: To establish the epidemiologic profile of holoprosencephalia and determine benefits of ultrasound and foetopathologic examination to the diagnostic. METHODS AN MATERIAL: [corrected] Retrospective study about 17 cases of holoprosencephalia observed in CMNT between Janaury 1992 and September 2000. RESULTS: Ultrasound diagnosis was made in 13 cases (75%). Ultrasound criteria were; absence of median structure of the brain and unique ventricule. The prognosis was always bad. Foetopathologic examination revealed 7 cases of lobar holoproencephalia and 10 of semi lobar. Fascial dysmorphia were noted in 82% of cases. CONCLUSION: The foetopathology and genetic counselling looking for fascial, dysmorphia in family's members gives a good evaluation of recurrences.

[Fatty liver disease and other complications of obesity]. / Steatose hepatique et autres complications de l'obesite.

Obesity induces many organic complications (somatic, metabolic and mechanical). The aims of this prospective study were to evaluate its complications in a group of thirty fat patients. Fatty liver disease, detected by echography is noted at 70% of patients. Clinically, it makes pains at the right side and seems favorized by an elevated BMI > 40 kg/m2, and diabetes, hypertriglyceridemiae, hypercaloric and hyperglucidic ration. 10% of our patients present stone bile duct associated to fatty liver disease.

[Epidemiology and development of macular edema in the diabetic]. / Epidemiologie et evolution de l'oedème maculaire chez le diabétique.

Macular edema is the first cause of blindness in diabetics. Macular edema is defined by macular thickening or deposits of hard exudates. On 1000 diabetics examined over 2 years, 60 patients had a macular edema of which we retained 38 cases(54 eyes). All the patients had an ophthalmologic examination with a retinal angiography. Laser photocoagulation with green Argon laser was instituted in 50 eyes. 63% had background rethinopathy. Total or partial regression of the edema happened in 84.4%. Laser photocoagulation decrease by the half vision loss risk. Interest of early detection and treatment to decrease blindness incidence of macular edema in diabetics.

[Antenatal diagnosis and contribution of fetopathologic examination in the management of omphalocele]. / Diagnostic antenatal et apport de l'examen foetopathologique dans la prise en charge de l'omphalocele.

The omphalocele is an average coelosomie, frequency of which is estimated at 1/5000 births. We confront diagnosis antenatal with the exam foetopathologic in purpose of 41 cases of omphalocele brought together over a period going from January 1, 1991 till December, 2000 in the unity of foetopathologie from the CMNT. The frequency of omphaloceles is 4.88% of the children malformed and of 1.64% of the set (group) of the performed an autopsy children. An association malformative was found in 85.4% of cases and a karyotype typical aberration trisomie 13.18 and 21 was identified in 17% of cases. The preview of the children bearers of this deformation is especially bound (connected) to the existence and to the gravity of associated abnormalities. The omphalocele required a multidisciplinary making coverage intervernir obstetriciens, néonatologistes, surgeons pediatre and foetopathologistes.

[Oligohydramnios and fetal malformation association]. / Association oligoamnios et malformations foetales.

L'Oligaminos is sometimes discovered during echographic exploration in obstetrics. Etiology is dominated by renal malformations, obstructive myopathies and polymalformatives syndromes therapeutic interruption of pregnancy needs to be discussed in case of bilateral renal malformation.

[Diabetes and the day hospital]. / Diabète et hopital de jour.

The day hospital is a relatively new way of hospitalization in Tunisia, the first experience beginning in 1985 to the National Institute of Nutrition. This hospitalization avoid the drawbacks of classic hospitalization (dependency, discomfort, separation) and boredom and present a lot of advantages of social command, humanitarian, psychological, medical and economical the cost of hospitalization is clearly reduced). This day hospitalization is beneficial in several pathologies notably the illness nutrition and metabolic diseases (diabetes, obesity, dyslipoproteinemia, hyperuricemia), where the patients continue to have a good physical activity and where the education médico sanitary and dietary hygiéno occupies a position of choice.

[Fetal pathology study of 88 cases of letal spina bifida]. / Etude foeto-pathologique de 88 cas de spina bifida létaux.

Lethal spina bifida continue to be frequent in Tunisia; we report 88 cases of letal spina bifida: 1.05 per thousand births. This pathology was more frequent with women. The up letal spina bifida situated is predominant with female and the dow spina bifida situated is frequent with male. We have noted an association with anencephalia (46 cases) and hydrocephaly (21 cases). Prevention is based on obstetric health care and hygiene dietetic advices to avoid alimentary deficit.

[Fetal pathology aspects of 97 cases of anencephaly. CMNR Tunisian study]. / Aspects foetopathologiques de 97 cas d'anencephalie: etude du CMNR Tunis.

So, the epidemiologic study done for 8 years at CMNR Tunis has shown that the incidence is 1.15@1000 births (between 0.52 and 1.66@1000 per year). This anomaly is more frequent in female sex (sex linked = 0.59). The antenatal echographic diagnosis is efficient in 90.5%. This anomaly is more shown at low socio-economic group. The improvement of the socio-economic level and specially the daily uptake of acid folic in periconceptionnel time decrease the frequency of this congenital malformation.

[Primary open-angle glaucoma and diabetes]. / Glaucome primitif à angle ouvert et diabète.

UNLABELLED: Open-angle glaucoma is most frequent in diabetics. Its evolution seems to be most severe although an equilibrated tonometry under glaucoma treatment in literature. AIM OF THE STUDY: comparison of evolution of glaucoma between diabetics and non diabetics. MATERIAL AND METHODS: A retrospective study of 72 glaucomatous patients diabetic and non diabetic was performed. A complete ophthalmologic examination with tonometry, funduscopy: sup disc measurement and automated perimetry was realised. Evolution was studied after chirurgical or medical treatment each four months with a mean follow up of 2 years. RESULTS: We observed that the evolution of Open-angle glaucoma in diabetics is significatively not different from non diabetics. CONCLUSION: Open-angle glaucoma evolution in diabetics is not more severe than general population.