Prevalence of gastroesophageal reflux in a Tunisian primary care population determined by patient interview.

Although gastresophageal reflux disease (GERD) is highly prevalent in Western countries, we have very little data about it in African countries. The aim of the study is to determine the prevalence and severity of GERD symptoms among Tunisian subjects and report its characteristics, consultation rate, management modes, as well as patients' satisfaction. Five hundred subjects living in Tunisia were interviewed face to face. The study was conducted at seven centers of primary care at Monastir's department by six interviewer doctors. The questionnaire consisted of 30 questions relating to subject attributes, lifestyle factors, medical history, reflux-related symptom characteristics, consultation behavior, previous treatments for GERD, and description of the last episode. Symptoms were defined as 'frequent' if they occurred at least weekly and 'occasional' if they occurred less frequently during the last year. The mean age was 42.3 ± 17.3 years and 75.6% were females. Over the previous year, 60% of the respondents reported suffering any GERD symptom. The prevalence of frequent GERD is 24%. Female gender (odds ratio [OR]: 1.97[1.15-3.37]) and body mass index ≥ 25 (OR: 1.54[1.042-2.29]) were associated with increased risk of GERD symptom. Only 22.3%, sought medical advice about GERD symptoms in the last year. In the univariate and multivariate analysis, work status, frequency and intensity of symptoms, duration of symptom, and association of atypical symptoms were associated with a higher frequency of medical consultation for GERD symptoms. Among the subjects complaining about heartburn, 34% took medications. GERD symptoms are common among Tunisian subjects. Few heartburn sufferers seek medical attention, and most do not take medications for symptomatic control.

[What are the distinctive characteristics of subjects with frequent and occasional gastroesophageal reflux symptoms?]. / Quels sont les caractéristiques distinctives entre les patients ayant un RGO fréquent et les reflueurs occasionnels?

BACKGROUND: The aim of this study was to determine the prevalence and clinical spectrum of gastroesophageal reflux disease (GERD) in Tunisia and to compare the characteristics and disease management of subjects complaining of at least weekly and less frequent gastroesophageal reflux symptoms. METHODS: Five hundred subjects living in Tunisia were interviewed face to face. The questionnaire consisted of 30 questions relating to subject attributes, lifestyle factors, medical history, reflux-related symptom characteristics, consultation behavior, previous treatments for GERD and description of the last episode. RESULTS: The mean age was 42.3±17.3 years and 75.6% were females. Sixty percent of the responders reported at least one GERD symptom. The prevalence of frequent GERD was 24%. Only 22.3% had sought medical advice about GERD symptoms in the last year. Of those who had consulted, 75% of individuals waited over 6 months before consulting a physician. Compared with subjects with occasional gastroesophageal reflux symptoms, those with frequent symptoms suffered from more severe symptoms, (OR: 3.5; CI 95%: 1.9-6.4), had more often sought medical advice (OR: 2.9 CI 95%: 1.6-5.2) and had more often used a drug therapy for GERD (OR: 2.2; CI 95%:1.3-3.8). In the multivariate analysis, work status, frequency and intensity of symptoms, duration of symptoms and association of atypical symptoms were associated with a higher frequency of medical consultation for GERD symptoms. CONCLUSION: GERD symptoms are common in the Tunisian population. The population with frequent GERD exhibits more severe symptoms and greater healthcare use.

[Cholestatic jaundice secondary to portal cavernoma: Case report]. / Ictère cholestatique secondaire à un cavernome porte: à propos d'un cas.

Portal biliopathy is due to compression of the common bile duct by varicose veins constituting portal cavernoma. Usually asymptomatic, it can occasionally be responsible for jaundice or cholangitis. We report a case of portal cavernoma secondary to pylephlebitis complicating acute appendicitis, followed eleven years later by occurrence of cholestatic jaundice. Diagnosis of portal biliopathy was done by imaging and confirmed by endoscopic retrograde cholangiography with insertion of a plastic stent into common bile duct. This stent was periodically changed and allowed regression of jaundice with a 3-year follow-up. Through a review of the literature, both clinical and therapeutic characteristics of portal biliopathy were studied.

[Antiphospholipid antibodies in digestive diseases]. / Les anticorps antiphospholipides en pathologie digestive.

DIAGNOSIS AND PROGNOSIS: Antiphospholipids comprise a very heterogeneous group of auto-antibodies including anticardiolipids demonstrated by immunological methods and lupus anticoagulants detected by coagulation tests. Antiphospholipids are encountered in various conditions other than dysimmune disease and are frequently involved in thrombotic manifestations. We discuss here the implications of these antibodies in digestive tract diseases and present an analysis of their diagnostic and prognostic value for optimal therapeutic and monitoring approaches. CLINICAL MANIFESTATIONS: The risk of thrombosis is high in patients with cryptogenetic inflammatory bowel disease. The prevalence of antiphospholipid antibodies (AcAPL) is abnormally high in these patients, but their contribution to the development of thrombosis remains controversial. Patients with liver disease generally exhibit coagulation disorders, with paradoxical thrombotic manifestations. AcAPL are strongly implicated in the development of thrombosis, particularly in patients with alcoholic liver disease, hepatitis C, regenerative nodular hyperplasia, and cirrhosis, independently of the presence of an associated hepatocellular carcinoma. Antiphospholipid syndrome is considered to be the second leading cause of non-tumor-related Budd-Chiari syndrome, after myeproliferative syndromes. Likewise for portal or mesenteric vein thrombosis where antiphospholipid antibodies would be involved in the causal mechanism. UNDERLYING MECHANISMS: Due to the diversity of these antibodies, it is unlikely that a unique mechanism could explain all the different thrombotic manifestations associated with their presence.

[Epidemiology of cholelithiasis in central Tunisia. Prevalence and associated factors in a nonselected population]. / Epidémiologie de la lithiase biliaire dans le centre de la Tunisie.

OBJECTIVES: The prevalence of cholelithiasis is still unknown in Tunisia. The aim of this study was to assess the prevalence and selected risk factors of cholelithiasis METHODS: Two thousand citizens over the age of 19 in a small town in the center of Tunisia were evaluated. Following a structured interview of each subject, an ultrasound examination was performed. Height, weight and blood levels of glucose and cholesterol were determined by standard methods. RESULTS: The response rate was 56% (746 women and 377 men). Of the 1123 persons evaluated, 19 had undergone previous cholecystectomy. Crude prevalence of cholelithiasis was 4% (5.4% in women and 1% in men). Typical biliary colic was the only symptom significantly associated with cholelithiasis (specificity: 97.6%). Presence of gallstones was associated with age (P=0.02), sex (P=0. 00045) and multiparity (P<0.0002). Neither body mass index, diabetes mellitus or hypercholesterolemia were risk factors. CONCLUSION: The prevalence of cholelithiasis in central Tunisia is low. The risk factors are similar to those in occidental surveys.

Adolescents' perceptions of substance abuse prevention strategies.

As part of a 3-year evaluation of substance abuse prevention strategies (Harding, Safer, Kavanagh, Bania, Carty, Lisnov, & Wysockey, 1996), this study examined the perceptions of 719 sixth- through ninth-grade Chicago public school students. School-based programs were rated as significantly more effective on six prevention objectives than were television ads, testimonials by famous people, billboards, and print ads displayed on public transportation. Students perceived the two school-based programs, Project DARE (a national program conducted through local police departments) and Captain Clean (an intense live theater program coordinated with student participation), as being equally effective overall, although the interactive theater program was rated as significantly better at encouraging students to talk about their feelings concerning substance abuse issues and at relating to the students' ethnic/racial backgrounds. When students were categorized according to frequency of alcohol use, nonusers, infrequent users, and frequent users differed significantly in their ratings of the school-based programs.

Using live theatre combined with role playing and discussion to examine what at-risk adolescents think about substance abuse, its consequences, and prevention.

Live theater is used as a means of stimulating thought and discussion among adolescents on topics related to the effects of substance abuse in their lives. A thirty-minute professional and contemporary live musical play, Captain Clean, was performed at three Chicago high schools (grades 9-12). In general, students in these schools had been judged to be at risk for drug problems by school administrators and by the Illinois Criminal Justice Information Authority. Students' responses to issues highlighted in the play were examined through ethnographic procedures used during role playing and discussion immediately following the performance. In addition, written comments were collected from the students two weeks after viewing. The amount of interaction and level of student response indicate that live theater is an effective means for stimulating both thought and discussion pertaining to the effects of drugs in the lives of adolescents. In addition, analysis of the students' responses reveals: (1) an unmet need for individual counseling; (2) a pervasive ignorance of the legal consequences of drug use; (3) the importance of family as a source of information and support; and (4) an expressed concern for their own futures as well as those of their peers.

Under pressure program: using live theatre to investigate adolescents' attitudes and behavior related to drug and alcohol abuse education and prevention.

This paper describes the Under Pressure Program, an innovative communication-centered approach designed to involve Chicago public junior and senior high school students in considering the problems and prevention of adolescent substance abuse. The centerpiece of the program is a 30-minute live musical play, Captain Clean, which incorporates extensive postperformance dialogue and role play to explore the pressures and feelings of adolescents regarding substance abuse. This unique blend of live entertainment and applied learning techniques enables adolescents to understand the pressures they face and teaches them to make responsible choices, in addition to serving as a vehicle for effective school and community substance abuse intervention. By going beyond the 60-second "just say no" television and radio campaigns, the Under Pressure Program addresses the underlying causes of adolescent substance abuse. Students are engaged in active participation rather than the traditional "teach and preach." The goals of the program are (1) to evaluate the effectiveness of live theatre in preventing and intervening in adolescent substance abuse, and (2) to examine the effectiveness of live theatre, via postperformance dialogue and role playing, in soliciting feedback from adolescents as to their own feelings about substance abuse and using school counselors and other available resources, and to build upon their recommendations for improving substance abuse prevention and intervention programs. The program is targeted at predominantly minority, low-income students who have been identified as "high risk." The Under Pressure format consists of four integral parts: faculty/staff community in-service: theatrical performance (Captain Clean); postperformance dialogue and role play; and student, faculty, counselor, and community follow-up.

Extensive cutaneous metastases from urinary bladder carcinoma.

Herein we present an update of the literature and a report of a recent case of cutaneous metastases from transitional cell carcinoma of the urinary bladder. Cutaneous metastases from bladder carcinoma more commonly affect middle-aged or elderly men and generally herald a rapid demise. Our case is unusual because of the rather extensive area of skin involvement, rapidity of development, and occurrence in a woman.

The effect of zinc on the sebum secretion rate.

In accordance with a randomized double-blind experimental design, capsules of zinc sulfate, 440 mg total daily dose, and lactose placebo were administered orally to 10 normal Caucasian males for 3 weeks. Sebum secretion rates and serum zinc levels were determined prior to and following treatment. There was a statistically significant change in the before and after mean sebum secretion rates of the zinc group when compared with those of the placebo group (p less than 0.028). The results of this preliminary study indicate that supplemental zinc sulfate may reduce the quantity of skin-surface sebum. Further investigation is warranted.