[Bulimia and anorexia among the teenagers]. / Boulimie et anorexie chez les adolescents.

BACKGROUND: The disturbances related to the feeding behavior are increasing in Tunisia. AIM: To evaluate the impact of an adapted and personalized therapeutic program, including dietetic advises and practice of yoga in Tunisian teenagers suffering from bulimia or anorexia. METHODS: Our study was carried out on 31 teenagers, old 16 to 19 years, 10 were anorexics (9 girls and 1 boy) and 21 were bulimics (14 girls and 7 boys). RESULTS: After twelve weeks of program application a clear improvement of the physical and mental state of our subjects was recorded. Indeed, an average fall of 7.3% of the body weight of the compulsive eaters and an increase of 6.6% of that of the anorexics were obtained. On the mental level, the frequency of the subjects which make daily crises passed from 29% to 19%. More half of the subjects (54.8%) paid more not to vomit but occasionally (less than one once out of two crises). CONCLUSIONS: These results show that an assumption of responsibility targeted of the teenagers suffering from food behavioral problems can help them to be left there.

[Metabolic profile of Tunisian obese adult]. / Profil Métabolique de L'adulte Obèse Tunisien.

BACKGROUND: Obesity is associated with multiple comorbidities such us metabolic and cardiovascular diseases. AIMS: Evaluate metabolic profile and to determinate the frequency of metabolic syndrome in Tunisian obese adult. METHODS: It's a prospective study realized in the unit of obesity research in the national institute of nutrition between April 2003 and March 2005.This study concerned two groups of subjects aged between 20 and 60 years old : Group 1 (n = 100) obese (BMI (3) 30 kg/m2) and group 2 (n= 60) controls with normal weight (BMI between 18,5 and 24,9 kg/m2). RESULTS: Mean number of metabolic complications is significantly higher (P < 10-3) in obese (3,28 +/- 2) than in controls (1,16 +/- 1,2). Impaired fasting glucose and type 2 diabetes mellitus are respectively more frequent in obese (37 % and 16 %) than in non obese (5 % et 1,7 %). Hyperinsulinemia is significantly (P<10-3) more frequent in obese. hypertriglyceridemia, hypercholesterolemia and hyperapolipoproteinaemia B are significantly (P = 0,01, P < 10-3 et P < 10-3) more frequent in obese than in no overweight subjects. The prevalence of hyperuricemia increased significantly (P = 0,01) in overweight subjects than in normal weight subjects. Metabolic syndrome is significantly more frequent (P < 10-3) in obese (48 %) than in control (1,7 %). CONCLUSION: Obesity, especially visceral obesity , is associated with a cluster of metabolic complications increasing the risk of coronary heart disease. We stress on the importance of primary prevention and early management of obesity.

[Distribution and prevalence of dyslipidemia in Tunisia: results of the Tunisian National Nutrition Survey]. / Distribution et prevalence des dyslipidemies en Tunisie: resultats de l'Enquete Nationale de Nutrition.

UNLABELLED: The aims of the study were to study the distribution of cholesterol and triglycerides and to assess the prevalence of dyslipemia in Tunisian adult population. METHODS: The Tunisian National Nutrition Survey (TNNS) was a cross sectional study performed on a total of 7860 adult subjects and was conducted on 1996-1997. The TNNS included 3087 adults over 20 years old. RESULTS: The mean values of cholesterol (CT) were more elevated in urban than rural area (p<0.001), and in females than in males (p<0.007). The overall prevalence of hypercholesterolemia (CT > 6.2 mmol/l) was 8.4% and that of hypertriglyceridemia (TG > 1.70 mmol/l) was 21%. The prevalence of borderline high cholesterol (> or =5.2-< 6.2 mmol/l) was 17%; These prevalences were more elevated in urban than rural areas (p <0.001) and increased with age in both genders (p < 0.001). The multiple adjusted odd ratio of the prevalence of hypercholesterolemia showed a positive correlation with female sex (OR 1.40 p <0.01), high waist circumference (OR 2.51 in men and 3.04 in women p < 0001) and urban residency (OR 1.35 p = 0.03). CONCLUSION: Our study showed the metabolic consequences of westernization style life in our country and should be the starter to preventive adequate policy.

[Bullosis diabeticorum: report of ten cases]. / La bullose des diabétiques: a propos de dix cas.

BACKGROUND: Bullosis diabeticorum is a rare characteristic complication of diabetes mellitus; it affects 0.5% of diabetics. Bullosis diabeticorum is a manifestation of complicate and longstanding diabetes mellitus. THE AIM: of our study was to describe particularities of diabetes in patients suffering of this disease. METHODS: We have led a retrospective study covering a 5 year-period (January 2001 - December 2007) in the dermatology department of the Charles Nicolle's hospital in Tunisia. We selected for this study all cases of bullosis diabeticorum. RESULTS: During the studied period, 10 cases have been collected. They were in all cases about complicate and long-standing diabetes. Bullosis diabeticorum has a favourable outcome in all cases with symptomatic treatment. CONCLUSION: The different cases of bullosis diabeticorum reported in our series were associated to complicate diabetes mellitus what lets suggest that vascular deteriorations led to cutaneous fragility responsible for the skin cleavage.

[How a diabetic lives during the month of Ramadan].

AIM: The research is about diabetic people who can fast Ramadan. In order to do so in a good physical health must have some stipulations. METHODS: In a certain research, about 278 diabetic people of the two types were examinated, making comparaison between those who were fasting and who weren't. RESULTS: 52,3% people are fasting of diabetic type 2 where's 18,4% people of diabetic type 1. 43% people who haven't spent yet five years affected by this disease. We have also noticed that 45% of diabetic type 2 fasting, and those who are older than 40 years have lost weight and improved their health. However, the blood sugar has deteriorate of those diabetic type 1 are fasting. CONCLUSION: Fasting Ramadan is possible for those diabetic type 2, and preferable plump people.

Aetiological factors and perception of anaemia in Tunisian women of reproductive age.

OBJECTIVES: To identify aetiological factors in anaemia and to explore knowledge, perceptions and attitudes towards anaemia. DESIGN: Two cross-sectional surveys and sixteen focus group discussions. SETTING: The two regions with the highest prevalence of anaemia in Tunisia, Greater Tunis (GT) and the South West (SW). SUBJECTS: Two representative samples of 687 (GT) and 729 (SW) women of reproductive age; 108 women were included in focus group discussions. RESULTS: Among anaemic women, 63.4% in the GT region and 80.2% in the SW displayed iron deficiency (ID). Genetic haemoglobinopathies accounted for 10.0% and 3.6% of the cases of anaemia in the two regions, respectively. After adjustment for confounders, the major factors for iron-deficiency anaemia were low dietary Fe intake (OR = 5.0, 95% CI 3.0, 8.4), drinking tea after eating (OR = 3.4, 95% CI 2.0, 5.7) and pica (OR = 2.1, 95% CI 1.1, 3.9). Most of the women related anaemia to the following causes: malnutrition, lack of hygiene, and their heavy workload and responsibilities in the household. Many women connected anaemia with hypotension. Few established a relationship between ID and anaemia. They had confidence in their doctor for treatment, but many complained they were not given sufficient information. Low dietary Fe intake, inappropriate food practices and inadequate perceptions contribute to the aetiology of anaemia in women. CONCLUSIONS: These results point out to the need for a strategy combining food fortification, Fe supplementation for pregnant women, nutritional education for the general public and at-risk specific target groups, and training of health professionals.

Tunisian children reference for body mass index and prevalence of obesity.

BACKGROUND: The prevalence of obesity in children is known to be increasing rapidly worldwide but few population-based surveys have been undertaken in North Africa and in the Middle East. AIMS: Report the means of body mass index with values corresponding to the different percentiles in boys and girls by age from a large nationally representative sample of the Tunisian children population. The second aim was to estimate the prevalence of obesity and over weight in children and adolescent using the 85th and 95th body mass index percentile respectively derived from the U.S.A. first National Health and Nutrition Survey and also the International cut off points for body mass index for overweight and obesity proposed by the International Obesity Task Force and Rolland Cachera. SUBJECTS AND METHODS: 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 3885 children and adolescent. RESULTS: The mean of BMI was of 16,63 +/- 2,58 Kg/m2 among boys and 17.36 +/- 3.52 Kg/m in girls. The BMI increased with age and more precociously in girls (10 years) that in boys (13-14 years). The mean+2SD of the BMI approached the 95th percentile. It is noticed that our 85th percentile and 95th percentile as well in the girls and in boys were lower than the same percentiles of the children of other countries (NHANES I, IOTF) and that our 97th percentile is higher than that of the French according to tables of Roland Cachera. By conside ring the NHANES I and the IOTF, the prevalence of obesity were rather weak (<5%) but high according to the tables of Roland Cachera (3 to 11%). CONCLUSION: The prevalence of obesity was low in 1996 according to references' of the NHANES I and IOTF but high according to tables' of Roland Cachera. Prevention of obesity by a healthy way of life remains the most effective means in the long and undoubtedly less expensive realizing programs of regular monitoring.

[Various types of anemia in children of 6 to 59 months]. / Les differents types d'anemie chez les enfants de 6 a 59 mois.

AIM: To assess the different kinds of anaemia in childhood METHODS: 468 children of Large Tunis and 487 children of the Western South like 744 of the urban environment and 211 children of the rural medium were studied. RESULTS: 21.3% of the old children from 6 to 59 months of Large Tunis present a ferriprive anaemia and 18% for the Western South. 20.7% of the children of the urban environment present against a ferriprive anaemia 19.1% for the rural medium but these results remain non significant. 1.1% of the children of Large Tunis present a martial anaemia associated with an ignition and 0.6% of the surveyed children are touched by this type of anaemia in the Western South. This association touches especially the urban environment with a rate of 1.1% against 0% for the rural medium. The proportion of the feeble children by deficiency in folic acid remains very low as for that by deficiency in B12 vitamin. The majority of the children of Large Tunis (2.9%) are touched by B minor thalassaemia and 1.3% of the children of the Western South are touched by the feature drépanocytaire. The major cause of anaemia for the children of less than 5 years thus remains ferriprive.

Food intake and high density lipoprotein cholesterol levels changes during ramadan fasting in healthy young subjects.

During the holy month of Ramadan, it is obligatory for all adult healthy Muslims to abstain from food, drink and smoking each day from dawn to sunset. The aims of our study were to evaluate the effects of Ramadan fasting on plasma lipids, lipoproteins and the change of food consumption in healthy subjects. Thirty young healthy and normal weighted adults (9 males and 21 females) were evaluated during three periods: 3 weeks before Ramadan (T0); the 4th week of Ramadan (T1) and 3 weeks after the end of Ramadan (T2). Main Clinical and biological parameters investigated were: body weight, blood glucose, plasma triglycerides (TG), plasma total cholesterol (TC), high density lipoprotein cholesterol (HDL-c) and. low density lipoprotein cholesterol (LDL-c) Body weight, and blood glucose were unchanged. There was a significant increase of the mean daily caloric intake, the lipids intake particularly mono-unsaturated and poly-unsaturated fatty acids (p < 0.001) and cholesterol intake (p < 0.001) during Ramadan with a decrease of the meal frequency. There was also a significant increase of plasma total cholesterol and HDL-cholesterol. The most striking finding was a significant increase in the HDL-Cholesterol during Ramadan +20% (p < 0.02). This increase was lost after Ramadan. Fasting Ramadan affects beneficially serum lipoprotein metabolism in young adult healthy subjects with an increase of HDL-cholesterol.

[Foot and diabetic neuropathy: about 205 cases]. / Pied et neuropathie diabetique: a propos de 205 cas.

Diabetic neuropathy is a serious and disabling complication of diabetes mellitus. It occurs in all types and at any moment of the evolution of diabetes. It can be worsened by arteriopathy or an associated cutaneous infection. Our study is about 205 diabetic patients with a peripheral neuropathy. In 27 patients (14% of cases) there are also trophic disorders: callus in zones of support (17 cases), mal perforant (6 cases) and burns (5 cases). Arteritis of the lower limbs was present in 50 % of cases. The authors discuss the physiopathology and management of diabetic neuropathy.

[Prevalence and causal factors of anemia in children in Tunisia]. / Prevalence et typologie des anemies chez les enfants de moins de 5 ans. Etude epidémiologique dans le Grand Tunis et le Sud Ouest.

Anemia continue to be prevalent among children under five years despite the improvement of socioeconomic and sanitary indicators. The purpose of the present cross-sectorial study is to assess the etiologic factors responsible for anemia. Knowledge of the relative importance of the different causes should form a basis for intervention strategies to prevent and control anemia. The survey covered 955 children under the age of five years, native of two regions with the highest prevalent of anemia, the Southwest and the District of Tunis. The results showed that 29% of children suffered from anemia. About 70% of them were iron deficient. The fractions of the deficiency in vitamin B12 and in folates were insignificant. Only 3% of children had chronic inflammation associated with (and possibly responsible for) their anemia A little fraction of anemia (approximately 5%) was due to thalassemia or drepanocytosis. Picawasan important causal factor of iron deficiency anemia. The parasites identified instool could not cause anemia.

[Xeroderma pigmentosum. Cutaneous, ocular, and neurologic abnormalities in 49 Tunisian cases]. / Xeroderma pigmentosum: manifestations cutanées, oculaires et neurologiques à partir de 49 patients tunisiens.

This is a retrospective study about 49 cases of xeroderma pigmentosum (XP). The goal was to determine the clinical features of XP in Tunisia. Our study revealed the predominance of a moderate form. Malignant skin tumors showed early. Squamous cell carcinoma (SCC) remainsed the most frequent skin malignancy in all clinical forms. Neurological abnormalities were more frequent in the moderate form. Mental retardation and peripheral neuropathy were the most common signs.

[Indications and results of vitrectomy in Terson syndrome]. / Indications et resultats de la vitrectomie dans le syndrome de Terson.

Terson syndrome or vitreal hemorrhage associated with subdural hemorrhage is a rare condition. The goal of our work through a retrospective series of 3 cases (4 eyes) is to study clinical characteristics as well as adequate moment of surgery. All our patients had unilateral or bilateral visual impairement secondary to cerebral lesion. Ophtalmologic exam showed an intravitreal hemorrhage. Two of our patients were operated by vitrectomy, the third case had a spontaneous resorption of intravitreal hemorrhage and no surgery was performed. Functional prognosis depends on neuro-ophtalmologic sequellas. Ophtalmic exam is essential in cerebral hemorrhage. For intravitreal hemorrhage spontaneous resorption is frequent and vitrectomy must be delayed.