Kidney biopsy in subsaharan Africa

Kidney biopsy (KB) is a significant advance in the management of nephropathies. In sub-Saharan Africa, few studies have been carried out. The objective of our study was to evaluate the indication, to determine the epidemiological and histological characteristics of the nephropathies diagnosed in sub-Saharan Africa.

Materials and methods

We carried out a retrospective and descriptive study on biopsies examined between January 2015 and December 2019, in the pathological departments of University Teaching Hospital of Bouaké and Cocody-Abidjan. The KB came from four countries (Côte d'Ivoire, Togo, Guinea-Conakry and Burkina Faso). Optical microscopy and/or direct immunofluorescence techniques were used. All biopsy samples including epidemiological, clinical and pathological data and an optical microscopy and/or direct immunofluorescence study were included. The parameters studied were indications for KB, epidemiological profile, clinic, proteinuria and pathological aspects.

Results

Over the study period, we collected 179 KB, i.e. 35.8 KB/year. The mean age of the patients was 32.9 ±13.8 years (range 11-70 years). The sex ratio (M/F) was 1.03. Pure nephrotic syndrome was the main indication (64.2 %, n = 115) for KB, followed by impure nephrotic syndrome (11.7 %, n = 21), acute renal failure (ARF) (7.8 %, n = 14) and rapidly progressive glomerulonephritis (RPGN) (7.8 %, n = 14). Glomerulonephritis (GN) occurred in 86 % (n = 158), vascular nephropathy in 11.7 % (n = 21) and tubulointerstitial nephritis in 2.2 % (n = 4). The nephropathies were preferentially focal segmental glomerulosclerosis (34.6 %, n = 62), nephroangiosclerosis (10.6 %, n = 19), membranous GN (10 %, n = 18), post-infectious GN (8.9 %, n = 16) and lupus GN (7.3 %, n = 13).

Conclusion

The KB is an essential step in the diagnosis of nephropathies. Focal segmental glomerulosclerosis is frequent in our study. The establishment of a Kidney registry would allow better knowledge of renal pathologies in sub-Saharan Africa.

Predictive factors of difficult biliary cannulation: An experience of a tunisian tertiary center

Introduction

Selective biliary cannulation is a prerequisite for a successful endoscopic retrograde cholangiopancreatography (ERCP). However, conventional biliary access can be difficult. The aims of our study were to determine the prevalence of difficult biliary cannulation (DBC) and its associated factors and to describe the efficiency and safety of used standard and advanced cannulation techniques.

Methods

We conducted a single-center retrospective study including all patients with naïve papilla who had an ERCP procedure in Gastroenterology department of Mohamed Taher Maamouri Hospital from June 2019 to December 2021. Efficiency was defined as successful selective deep biliary cannulation. DBC was defined based on the presence of one or more of the European Society of Gastrointestinal Endoscopy (ESGE) criteria (5-5-1): more than five cannulation attempts, more than 5 min before cannulation and more than one accidental passage in the wirsung. Prevalence was measured using ESGE 5-5-1 cutoffs and chinese set cutoffs 15-10-2. Predictors of DBC were sought by univariate and multivariate analysis (SPSS software, p significant if < 0.05).

Results

We included 664 patients (mean age 62 years and sex ratio M/W = 0.8). Main indication for ERCP was choledocholithiasis (67%, n = 442) followed by malignant biliary stenosis (21%, n = 138). Based on ESGE criteria, prevalence of DBC was 42.62% (n = 283). Prevalence was 21.15% when 15-10-2 cutoffs are applied in trainee-involved procedure. Cumulative biliary success rate was 96.46%. Standard cannulation method achieved access in 98.2% while advanced methods permitted success in 92.2% in fistulotomy, 94.1% in papillotomy and 77.3% in transpancreatic sphincterotomy. Independent predictive factors of DBC in multivariate analysis were: Trainee presence OR 1.80 [1.24-2.65], SOD OR 4.71 [1.11-19.88], biliary stenosis found on imaging examinations (OR 2.53 [1.63-3.92], small papilla OR 4.09 [1.82-9.17] and difficult orientation of the papilla OR 14.90 [3.28-67.62].

Conclusion

DBC is a frequent endoscopic situation. Predictors of DBC can be related to trainee involvement in the procedure, anatomical and clinical factors. A thorough understanding of these factors can actively contribute to ERCP management plans.

Incidence cumulée de l'infection au SARS-CoV-2 à l'Institut Pasteur de Tunis, mars 2021

Contexte

L'Institut Pasteur de Tunis (IPT) a été impliqué dans les activités de diagnostic biologique de l'infection par le SARS-CoV-2. De nombreux cas d'infection par le SRAS-CoV-2 ont été détectés parmi le personnel de l'IPT, mais la véritable propagation de l'infection au sein de cette institution était inconnue. Notre étude visait à mesurer l'étendue de l'infection par le SRAS-CoV-2 parmi les agents de l'IPT et de déterminer la proportion d'infections asymptomatiques.

Méthodes

Une enquête transversale exhaustive auprès des agents de l'IPT non encore vaccinés contre la COVID-19 a été menée au cours des deux dernières semaines de mars 2021 qui coïncidaient avec la fin de la deuxième vague de COVID-19 en Tunisie. Les échantillons de sérum collectés auprès des participants ont été testés à l'aide de deux tests ELISA développés à l'IPT pour détecter les immunoglobulines G dirigés contre le domaine de liaison au récepteur (RBD) de la protéine de pointe S (IgG anti-S-RBD) et contre la protéine de nucléocapside N (IgG anti-N) du virus SARS-CoV-2.

Résultats

Au total, 428 personnes ont été incluses dans l'étude. La prévalence des anticorps anti-SARS-CoV-2 (IgG anti-N et/ou IgG anti-SRBD) était de 32,7 % (intervalle de confiance 95 % : [28,0-36,9]) (22,2 % [18,2-25,9] avaient des IgG anti-N et 31,3 % [26,9-35,7] avaient des IgG anti-S-RBD). L'incidence cumulée de l'infection par le SRAS-CoV-2 (sérologie positive et/ou test RT-PCR antérieur positif) était de 39,7 % [35,0-44,2]. La proportion de formes asymptomatiques était de 32,9 %.

Discussion/Conclusion

s Nos résultats ont révélé une incidence relativement élevée d'infection par le SARS-COV-2 parmi les agents de l'IPT. Les échantillons recueillis avant la vaccination seraient très utiles pour les enquêtes séro-épidémiologiques de suivi post-vaccinal. La proportion considérable d'infections asymptomatiques souligne l'importance de l'intensification de la pratique des tests de dépistage pour rompre la chaine de transmission de l'infection.

Déclaration de liens d'intérêts

Les auteurs déclarent ne pas avoir de liens d'intérêts.

Assessment of COVID-19 vaccine literacy among cancer patients: A cross sectional Tunisian study

Background

In the context of the COVID-19 pandemic, Vaccine literacy (VL) is considered as an important determinant of vaccine hesitancy and uptake. Cancer patients constitute a target group for COVID-19 vaccination. Thus, we aimed in this study to assess COVID-19 VL among cancer patients in Tunisia.

Methods

A cross sectional study was conducted, during the month of February 2021, in the Salah Azaiez institute of cancer including all inpatients aged ≥18 years. A standardized VL scale was used, composed of two dimensions: functional VL and interactive-critical VL, using a four point Likert scale. A global score was calculated for each scale (ranging from 1 to 4); A cutoff of 2.5 was defined according to the literature. The students' t and Anova tests were used for comparison of VL mean scores according to the studied characteristics. A p value &lt;0.05 was considered as statistically significant.

Results

A total of 200 patients were enrolled in this study with a mean age of 54.4±12.7 years. A low VL score (≤ 2.5) was observed among 27.5% and 81.0% participants for functional and interactive critical scales respectively. Higher functional VL score was associated with a higher educational level (3.7±0.5 among individuals with a university degree level vs 2.5±1.2 among illiterate, p &lt; 0.001). Interactive critical VL significantly increased with educational level (p &lt; 0.001) and was significantly higher among healthcare workers (2.5±1.3 vs 1.7± 0.9, p &lt; 0.001), those who accepted to get the COVID-19 vaccine (2.0±0.9 vs 1.6±0.8, p = 0.002), who did not believe that vaccines are unsafe (1.9±0.9 vs 1.4±0.7, p &lt; 0.001) and that there is no need to be vaccinated since natural immunity exists (2.1±1.0 vs 1.7±0.8,p=0.016).

Conclusions

Vaccine literacy among cancer patients included in this study is weak. Effective communication strategies about COVID-19 vaccination should build VL and consider the level of patient's health literacy to redress vaccine hesitancy and uptake.

Key messages

This study showed a low interactive-critical vaccine literacy score. Communication strategies in vaccination campaigns should be aligned with people’s vaccine literacy.

Determinants of healthcare workers’ willingness to receive the influenza vaccine in Tunisia

Background

Influenza is a contagious respiratory disease that may lead to severe illness. Given their frequent contact with ill individuals, healthcare workers (HCWs) are at elevated risk of developing influenza and of transmitting the disease to their patients. We aimed in this study to assess flu vaccination intention among Tunisian HCWs and to identify its determinants.

Methods

A cross sectional study was conducted among Tunisian HCWs with direct patient contact during the 2018-2019 influenza season. Participants were recruited in primary and secondary healthcare facilities according to a self-weighted multistage sampling. Factors associated with influenza vaccination intention were assessed using a multivariate logistic regression analysis.

Results

In this study, 1231 HCWs were enrolled with a mean age of 44.5±9.3 years and a sex ratio equal to 0.25. Among respondents, 43.1% (95% CI: [40.0-45.8]) declared their willingness to receive the IV if recommended for HCWs and provided for free. Participants who received the IV during the 2018-2019 influenza season ((ORa=34.42 [16.41-72.21]), who knew that IV is indicated annually for HCWs (ORa=1.66 [1.21-2.30]), who had high confidence regarding IV efficacy (ORa=1.99 [1.48-2.68]), who believed that IV should be mandatory for HCWs (ORa=2,36 [1.76-3.18]) and that HCWs' vaccination against influenza is important in order to protect patients (ORa=1.92 [1.37-2.69]) were more likely to be willing to receive the IV. However, nurses were less likely to be willing to receive the vaccine than physicians (ORa=0.66 [0.44-0.98]).

Conclusions

Less than half of participants reported their willingness to receive the IV. Our results suggest that flu vaccination acceptance is associated with higher IV uptake and with favorable attitudes regarding influenza vaccination. This highlights the need to implement regular flu awareness campaigns in healthcare facilities aiming to encourage vaccination among HCWs.

Key messages

Majority of healthcare workers reported their unwillingness to receive the influenza vaccine. Educating health personnel about the benefits of influenza vaccination to themselves and their patients is necessary.

Trans fatty acids policy analysis to prevent non-communicable diseases in Tunisia

Background

Despite the widely published international guidelines for a better implementation of health policies promoting healthy eating habits; the epidemiological situation regarding most weighing heavily non-communicable diseases (NCDs) on global health, is still alarming. We aimed to analyze Tunisian health policies targeting trans fatty acids (TFA) consumption to prevent and control NCDs.

Methods

Based on in-depth policy content analysis and stakeholder interviews, Tunisian policies related to promoting healthy diets and restricting unhealthy consumption of TFA, were identified. Four sub-components of WHO best-buys were assessed: goal to eliminate industrially-produced TFA, legislation to ban their use in food chain, TFA labeling and fiscal policies, and mass media campaign to promote healthy diet and reduce TFA intake. Findings were analyzed based on three main axes of the “policy cube approach”: comprehensiveness of policy content, policy effectiveness and respect of equity principles. For each axis, final assessment was performed based on a Likert scale: low, moderate and high.

Results

Although (3/4) WHO best-buys are covered by the national strategies for NCDs and obesity prevention for 2018-2025 and 2013-2017 respectively. This analysis has revealed moderate level for comprehensiveness of policy content, because ofthe absence of specific mention regarding legislation. A moderate level in policy salience and effectiveness was also highlighted (weak accountability mechanisms and no budget line for effective implementation for all WHO best-buys). A very low respect to equity principles was also underlined with no specific attention regarding vulnerable populations.

Conclusions

Main weaknesses in TFA policies concerned legislation, budget allocation and accountability mechanisms. “Legislation measures” to ban trans-fats use in the food chain and resource mobilization for “nutrition labeling and mass-media campaigns” effective implementation, are recommended.

Key messages

Several weaknesses in TFA policies have been highlighted, mainly related to: legislation, budget allocation, accountability mechanisms and low respect to equity principles. Legislation reinforcement and efficient resource mobilization for “nutrition labeling and mass-media campaigns” effective implementation, are strongly recommended.

Attitudes and beliefs regarding current vaccines among Tunisian cancer patients

Background

Vaccines constitute a successful and cost-effective public health tool. Whereas, skepticism regarding their safety and efficacy remains prevalent. We aimed in this study to assess attitudes and beliefs regarding current vaccines among cancer patients in a national Tunisian center for cancer care.

Methods

A cross sectional study was conducted, during the month of February 2021, among hospitalized patients in the oncology unit of the Salah Azaiez Institute of cancer. We included patients who were aged 18 years and over and who were able to respond to the questionnaire. A standardized questionnaire was administered to patients to assess their attitudes and beliefs regarding current vaccines. Chi square test was used for comparing percentages and a p value <0.05 was considered as statistically significant.

Results

A total of 200 patients were included with a mean age of 54.4±12.7 years. The willingness to receive influenza and COVID-19 vaccine were respectively of 39.0% and 35.0%. A higher proportion of 69.0% was observed for the willingness to receive vaccines against other infectious diseases. Among surveyed patients, the high majority (81.0%) agreed with the fact that there is no need to be vaccinated because native immunity exits and or because vaccines are unsafe. This belief was significantly associated to patients' unacceptance of COVID-19 (91.3% vs 63.8%, p < 0.001), influenza (86.8% vs 72.7%, p = 0.013) and other infectious diseases vaccines (93.5% vs 75.9%, p = 0.003).

Conclusions

This study reported low acceptance proportions of influenza and COVID-19 vaccines and that false beliefs constitute a threat to vaccine acceptance. Healthcare professionals should educate and encourage cancer patients to be vaccinated, especially against COVID-19, influenza and pneumococcal infections.

Key messages

Low acceptance proportions of influenza and COVID-19 vaccines, were found in this study.

Improving communication strategies in order to redress false beliefs and increase vaccine acceptance is recommended.

Impact of mandatory institutional quarantine on sleep quality: A cross sectional Tunisian study

Background

Given the COVID-19 pandemic, Tunisian authorities have imposed quarantine in dedicated centers mainly for travelers coming from countries with highest coronavirus infection rates. Such restrictive measures may have a detrimental impact on people's mental health and can thus affect sleep. We aimed in this study to assess the impact of mandatory institutional quarantine on sleep quality in Tunisia and to determine factors associated with clinical insomnia.

Methods

Data were collected through a cross sectional study conducted from April to November 2020 among individuals who were in quarantine for 14 days including at least a week in a Tunisian quarantine center. Sleep quality was assessed using the Insomnia Severity Index. Factors associated with clinical insomnia were assessed using bivariate and multivariate analysis.

Results

In the present study, 506 participants were included with a mean age of 37.6±13.6 years. Majority (66.4%) were men. Nearly one fifth (19.2%) of surveyed individuals had symptoms of clinical insomnia. In multivariate analysis, we found that being a woman, spending longer time on covid-19 news per day, having experienced stigma during the quarantine period, financial difficulties due to the coronavirus pandemic and dissatisfaction by the accommodation conditions of the quarantine facility were independently associated with clinical insomnia.

Conclusions

Nearly one fifth of participants had clinical insomnia during the quarantine period. Providing a good sleep environment, educating sleep healthy behavior and giving adequate psychological support to quarantined individuals in quarantine centers is necessary.

Key messages

Among surveyed participants, 19.2% had symptoms of clinical insomnia.

Providing a good sleep environment in quarantine centers and providing mental health support to quarantined individuals is essential.

Cancer mortality attributable to cigarettes smoking in Tunisian adults, 2016

Background

The carcinogenic effect of tobacco smoking has been well established. In Tunisia, cancers ranked second leading cause of deaths from non-communicable diseases in 2014. In addition, Tunisia is classified among North African countries with the highest prevalence of tobacco smoking. We aimed in this study to estimate cancer mortality attributable to current cigarettes smoking among Tunisian adults aged 30 years and older in 2016.

Methods

Cancer mortality attributable to current cigarettes smoking was estimated using the population attributable fraction method. This estimation requires to have the number of deaths by cause, age and gender, the prevalence of tobacco use by age and gender, and the relative risks (RR) as measure of associations of tobacco use and diseases related to tobacco. The age and cause specific number of deaths were obtained from the health metrics database. The relative risks were mainly obtained from the Cancer Prevention Study II and the prevalence of current cigarettes smoking in Tunisia was taken from the Tunisian Health Examination Survey, a nationally representative household survey conducted in 2016.

Results

In 2016, 2410 and 31 deaths among Tunisian men and women respectively were attributable to current cigarettes smoking accounting for 54.3% and 1.7% of all deaths from cancers. Among neoplasms, lung and upper aerodigestive tract cancers had the highest proportion of deaths attributable to tobacco smoking. They were responsible for 1702 and 392 deaths attributable to current cigarettes smoking corresponding to 74.5% and 49.1% of the total number of deaths from lung and upper aerodigestive tract cancers respectively.

Conclusions

More than half of cancer deaths among Tunisian men were attributable to current cigarettes smoking. The enforcement of smoking free legislation and the promotion of smoking cessation interventions are thus necessary.

Key messages

Majority of all cancer deaths observed among Tunisian men aged 30 years and over in 2016 were attributable to current cigarettes smoking. Lung cancer had the highest proportion of deaths attributable to Tobacco.

Assessment of glycemic control among Tunisian diabetic adults

Background

Diabetes, a major public health issue in Tunisia, is responsible of an increased burden of morbidity and premature mortality. Achieving a good glycemic control is essential for reducing the morbidity-mortality associated with this disease. The purpose of our study was to assess the proportion of uncontrolled diabetes (UD) among Tunisian diabetic adults and assess associated factors.

Methods

A national household survey, stratified at three degrees, was conducted in 2016. As part of this study, we included previously diagnosed diabetic adults aged 20 years or above. Sociodemographic data and medical history were collected using an individual questionnaire, and glycated hemoglobin (HbA1C) was measured using the “A1C Now +” device. The UD was defined based on the American Diabetes Association criteria for the year 2016 (HbA1c ≥7%). Multiple logistic regression model was used to determine factors associated with UD. Adjusted Odds Ratios (AOR) were presented with 95% confidence intervals (CI). All data analysis was performed using SPSS software.

Results

A total of 873 subjects were included with a median age of 61 years and a sex-ratio equal to 0.9. The proportion of UD was (72.8%, 95% CI: [69.1-76.3]). In multivariate analysis, UD was more frequent among rural areas residents (AOR=1.8 [1.1-2.7]), those who had never seen a doctor within the year preceding the survey (AOR=2.2 [1.1-4.2]) and among those on oral antidiabetics (AOR=6.1 [1.9-18.9]) or insulin (AOR=23.8 [7.1-79.8]) compared to those who were following a diabetic diet.

Conclusions

This study highlighted a very high proportion of UD in diabetic Tunisian adults. A better involvement of primary care physicians in overall patient care, and improved availability of antidiabetic drugs for patients, are strongly recommended.

Key messages

Majority of Tunisian diabetic adults aged 20 years or older had an uncontrolled diabetes. Improving patient education and the availability of antidiabetic drugs for diabetic individuals in primary healthcare facilities is essential.

Anxiety and depression among individuals in mandatory institutional quarantine in Tunisia

Background

The COVID-19 pandemic is a challenging public health issue that have impacted people's health and livelihoods worldwide. Restrictive measures, such as quarantine, have been implemented in many countries in order to limit the spread of the virus. We aimed in this study to assess the impact of institutional mandatory quarantine on mental health in Tunisia and to determine factors associated with the occurrence of anxiety and or depression.

Methods

A cross sectional phone survey was conducted in Tunisia from April to November 2020 among people who were placed in mandatory institutional quarantine. Generalized anxiety disorder and depression were assessed using the Generalized anxiety disorder scale (GAD-7) and the Centre for Epidemiological Studies Depression Scale (CES-D-10). Bivariate and multivariate analyses were used to determine factors associated with the occurrence of depression and or anxiety symptoms.

Results

In the present study, 506 participants were enrolled with an age ranging from 18 to 83 years and a sex ratio equal to 1.9. More than third of participants (38.3%) had experienced anxiety and/or depressive symptoms. Being a woman, younger age, being a student, spending longer time on COVID-19 news, fear of infection in the quarantine facility, having experienced stigma, financial struggle due to the COVID-19 pandemic and dissatisfaction by the accommodations conditions of the quarantine facility were independently associated with occurrence of depression and or anxiety symptoms.

Conclusions

A high percentage of participants have experienced anxiety or depressive symptoms during the quarantine period. Providing mental health support and updated and relevant information to quarantined individuals is necessary. Improving the accommodation conditions in the quarantine facilities is also needed.

Key messages

More than third of participants had experienced anxiety and/or depressive symptoms. Good quality communication and mental health support are necessary in quarantine facilities.

Premature mortality attributable to tobacco smoking among Tunisian adults in 2016

Background

Tobacco smoking is a major risk factor for several debilitating health conditions, causing thus premature deaths and disability. Globally, 8 million deaths, mainly occurring in low and middle income countries, are attributable to tobacco use each year. We aimed in this study to estimate the premature mortality attributable to current cigarettes smoking among Tunisian adults aged 35-69 years.

Methods

The population attributable fraction (PAF) method was used to estimate the number of premature deaths attributable to smoking. The estimates for the total number of deaths in Tunisia in 2016 by causes were obtained from the health metrics database. The current cigarettes smoking prevalence was taken from a nationally representative household survey conducted in 2016 and the used relative risks were obtained from the cancer prevention study II of the American Cancer Society.

Results

A total of 3219 premature deaths were attributable to current cigarettes smoking accounting for 23.1% (34.2% in men and 2.1% in women) of the total number of deaths. The leading causes of premature mortality attributable to smoking were lung cancers (PAF= 79.6%), chronic obstructive pulmonary diseases (PAF= 54.5%) and upper aerodigestive tract cancers (PAF= 54.3%).

Conclusions

Nearly a quarter of premature deaths in Tunisia in 2016 were attributable to tobacco smoking. This underscores the need to enhance the MPOWER measures application mainly through the promotion of anti-tobacco awareness campaigns and the reimbursement of smoking cessation treatments.

Key messages

Tobacco smoking were responsible for a significant percentage of premature deaths mainly among Tunisian men in 2016. Our results highlight the urge to enhance the MPOWER measures application in Tunisia.

COVID-19 vaccine hesitancy among Tunisian cancer patients in the Salah Azaeiz Institute of Cancer

Background

Vaccination against SARS-CoV-2 is the most effective way to stop the pandemic and to avoid its related deaths. COVID-19 vaccine hesitancy, represent now a major hurdle to achieve herd immunity. Cancer patients constitute a prioritized group for COVID-19 vaccination as they are particularly vulnerable to severe infection and death. The aim of this study was to assess vaccine hesitancy among cancer patients of the Salah Azaiez Institute (SAI) of cancer and to identify its knowledge and attitudes associated factors.

Methods

A cross sectional study was conducted among all inpatients aged above 18 years old during the month of February 2021. Participants were asked according to a well-structured questionnaire about knowledge (vaccine literacy) and attitudes towards COVID-19 vaccine. Vaccine literacy was assed using two scales (functional and interactive-critical scales) for which a global score was calculated ranging from 1 to 4. A lower score corresponding to lower vaccine literacy. Chi square test and student's t test were used to identify knowledge and attitudes associated with COVID-19 vaccine hesitancy. A p value equal or less than 0.05 was considered statistically significant.

Results

Two hundred cancer patients were included with a mean age of 54.4±12.7 and a gender ratio equal to 0.5. Sixty-five percent reported that they would not receive the COVID-19 vaccine. Vaccine hesitancy was associated with lower interactive vaccine literacy score (1.6±0.8 vs 2.0, p = 0.002), skepticism regarding COVID-19 vaccine efficacy and safety (73.8% vs 38.5%, p < 0.001) and believing that health authorities will not be able to vaccinate the majority of the population (71,2% vs 55.7% p = 0.037).

Conclusions

The proportion of COVID-19 vaccine hesitancy among cancer patients is high. Mass media campaigns for vaccine promotion should be enhanced. Physicians and health care workers play a key role in increasing acceptance and uptake of COVID-19 vaccine among high risk patients.

Key messages

Majority of cancer patients were unwilling to receive the COVID-19 vaccine.

Patient education about the benefits of vaccination against SARS-CoV-2 should be an integral part of oncology visits.

[Efficacy of highly active antiretroviral therapy alone in the treatment of diffuse lymphocytic infiltration syndrome in an ivorian patient living with HIV: a case report]

Objective

We report in this work the efficacy of highly active antiretrovirals (ARVs) alone in the treatment of diffuse infiltrative lymphocytosis syndrome (DILS) without the use of corticosteroids, which appears risky in patients living with HIV.

Observation

This is a 60-year-old HIV-positive patient, discovered during the etiological workup of renal failure, which revealed a non-nephrotic glomerular profile. The renal biopsy found an interstitial infiltrate of CD8 suggestive of DILS. Management consisted in starting ARV treatment alone (lamuvidine, abacavir and raltegravir) without associated corticosteroid therapy. The clinical evolution under treatment was marked by a recovery of the renal function with a creatininemia at 99 μmol/l, a regression of the proteinuria, a CD4 rate at 293/mm³ and an HIV viral load at 533.3 copies or 1.6 log in the space of 3 months.

Conclusion

DILS is a diffuse systemic disease in HIV patients who are usually under poor virological control. In view of the strong immunosuppression and the absence of other infiltrative diseases, it appeared to us to be risky and unjustified to add a corticosteroid therapy.

Health care renunciation in Tunisian diabetic patients, 2016

Background

Diabetes management requires access to health care, patient awareness about hygiene and diet measures, and patient adherence to prescribed treatment. Health care renunciation (HCR) can make diabetes management really challenging. We aimed to determine the prevalence of HCR in diabetic Tunisian patients and assess associated factors.

Methods

Data were obtained from the 2016 Tunisian Health Examination Survey, a household survey stratified at three degrees. For each household, two people aged 18 and over were randomly selected. Data were collected using: a household questionnaire and an individual questionnaire (risk behaviours and medical history). Diabetic patients were asked whether, they had renounced any health care service, the last time they needed to seek healthcare. Data analysis was performed with R software.

Results

A total of 880 diabetic patients were included in this survey, with a mean age of 61±12 years and a sex ratio M/F equal to 0.9. The prevalence of HCR was 4.9% (95% CI [3.3-6.5]), higher in men (7.4% VS 2.6% in women, p = 0.003) and higher in urban areas (5.4% VS 3.1 in rural areas, p = 0.09). After multivariate adjustment (taking into consideration age, gender, profession, health insurance and place of residence as independent variables), having no health insurance and being aged more than 50, were significantly associated to HCR, with adjusted Odds Ratios equal to (3.8, 95% CI [1.4-9.2]) and (3.4, 95% CI [1.9-10.1]), respectively.

Conclusions

Our study has highlighted a relatively low prevalence of HCR compared to literature data (4.9% VS 10-15%), explained mostly by methodological differences regarding HCR assessment. HCR in diabetic patients is mostly explained by economic reasons, which show how important is a better organisation of Tunisian public health system to ensure equity in access to health care.

Key messages

Health care renunciation in diabetic Tunisian patients is explained mainly by financial reasons (having no health insurance). Moving further towards improving universal health coverage is a key pillar in the proper management of chronic diseases such as diabetes.

Willingness of healthcare workers to recommend seasonal influenza vaccine to patients- Tunisia, 2019

Background

Most countries of the Eastern Mediterranean Region have low influenza vaccination coverage mainly among high risk groups. Advice to receive the influenza vaccine by healthcare workers (hcws) seems to be an important motivator for vaccine acceptance among patients. In this study, we aimed to describe the willingness of Tunisian hcws to recommend the seasonal influenza vaccine to patients and to assess its determinants.

Methods

A cross-sectional questionnaire-based study was conducted in Tunisian primary and secondary healthcare facilities during the 2018-2019 influenza season. A multivariate logistic regression was used to assess the factors associated with the willingness of hcws to recommend the influenza vaccine to patients.

Results

In the present study, 1231 hcws were included with a mean age of 44.5±9.3 and a sex ratio (Male/Female) equal to 0.25. Among respondents, more than three quarter (79.1%, 95% CI: [76.7-81.3]) declared their willingness to recommend the influenza vaccine to patients if available. In multivariate analysis, belief that influenza vaccine is a severe illness that may lead to death (adj.OR = 2.9, 95% CI: [1.9-4.1]) and previous influenza vaccine uptake among health professionals (adj.OR = 2.4, 95% CI: [1.5-3.9]) were independently associated with the willingness of hcws to recommend the flu vaccine to patients.

Conclusions

This study showed that hcws with a history of influenza immunization and those who were aware of influenza severity were more likely to be willing to recommend the influenza vaccine to patients. These findings should be considered in future educational programs to enhance hcws' recommendation of influenza vaccine.

Key messages

Majority of Tunisian healthcare workers declared their willingness to recommend the influenza vaccine to patients. Healthcare workers’ awareness of influenza severity and history of influenza vaccine uptake were associated with a higher willingness to recommend the flu vaccine.

Determinants of influenza vaccination intention among Tunisian elderly

Background

Influenza vaccination coverage among elderly remains unsatisfactory even in developed countries. Since attitudes are predictors of behavior, understanding factors influencing the intention to receive influenza vaccine (IV) among elderly may orientate interventions to increase vaccination rate. The aim of the current study was to identify factors associated to willingness to receive IV next season among Tunisian elderly.

Methods

During 2018 -2019 flu season a cross-sectional study was conducted among older persons aged 60 years and over with chronic disease attending primary and secondary health care facilities. The intention to get vaccinated against influenza was measured by means of a face to face questionnaire. Factors that affect willingness to receive IV were identified using a multiple logistic regression analysis.

Results

Of the 1191 older persons included, 19.4% [17.1-21.9] participants received IV in 2018-2019 flu season, 64.7% [61.9-67.3] expressed willingness to be vaccinated next season. Willingness to receive IV was more likely among persons with chronic pulmonary disease (ORa=2.6), those suffering from diabetes (ORa=1.6), those who received IV in 2018-2019 flu season (ORa=16.5), those who feel that they get enough information about vaccines and their safety (ORa=2.9) and persons who trust the advice of their health care providers (ORa=4.5).

Conclusions

Vaccination status was the most determinant factor associated to willingness to receive the vaccine. Therefore, sustainable efforts to promote IV may lead to cumulative increase of influenza vaccination coverage year by year. Doctors should be involved more in advocating IV and providing elderly with the necessary information about IV, but that could not be effective without a climate of trust between patients and health care providers.

Key messages

Positive self-experience of older persons with IV may change their perception about it and encourage them to adhere to the vaccine in the future. Elderly should be provided with the necessary information about IV in terms of effectiveness and safety.

Influenza immunization among Tunisian health care workers in the 2018-2019 influenza season

Background

Given the nature of their activities, health care workers (hcws) are at higher risk of contracting influenza and transmitting the disease to their patients. Influenza vaccine (IV) remains the most effective way to prevent influenza and its complications. To the best of our knowledge, no national data on IV coverage among hcws is available in Tunisia. The present study aimed to assess the flu vaccination coverage among Tunisian hcws in the 2018-2019 influenza season and factors associated with IV uptake through a study of knowledge and attitudes related to influenza vaccination.

Methods

A cross sectional study was conducted in Tunisian primary and secondary health care facilities from March to May 2019. Hcws with direct patient contact were recruited according to a self-weighted multistage sampling. Survey data collection was based on a face to face questionnaire containing both open and closed questions.

Results

A total of 1231 hcws were enrolled in this study. Among respondents, 15.3% (95% CI: [12.3-17.2]) were vaccinated against influenza during the 2018-2019 influenza season. High confidence regarding vaccine efficacy (OR = 3.5, 95%CI: 2.5-4.8), belief that hcws' influenza immunization may decrease illness and deaths among patients (OR = 1.7, 95% CI: 1.2-2.3) and belief that influenza vaccination can reduce work absenteeism (OR = 1.7, 95% CI: 1.2-2.4) were associated with a higher IV uptake among hcws. In addition, participants who mentioned hcws as a target group for influenza vaccination (OR = 2.0, 95% CI: 1.5-2.8) and who were agree that IV is indicated annually for hcws (OR = 3.1, 95% CI: 1.9-4.9) were more likely to receive the IV.

Conclusions

Influenza vaccination coverage among Tunisian health professionals in 2018-2019 was low. Our findings suggest that knowledge and attitudes regarding influenza vaccine influence vaccine compliance among hcws and should thus be targeted by vaccination campaigns to promote flu vaccine uptake in the health community.

Key messages

Vaccination coverage among Tunisian healthcare workers was low in the 2018-2019 influenza season. Our findings suggest that knowledge and attitudes regarding influenza vaccine influence vaccine uptake among Tunisian health care workers.

Prevalence, awareness and control of hypertension among Tunisian adults, 2016

Background

Hypertension is becoming increasingly frequent mainly in low and middle income countries. We aimed to assess the prevalence, awareness and control of hypertension among Tunisian adults and identify associated factors with hypertension control.

Methods

Data were obtained from the 2016 Tunisian Health Examination Survey, a household survey stratified at three degrees. Adults (age≥18 years old) were interviewed using an individual questionnaire, then three blood pressure measurement were performed. Participants were considered hypertensive if they were previously diagnosed or had a systolic blood pressure (SBP) ≥140mmhg and/or a diastolic blood pressure (DBP) ≥ 90mmhg during the survey. Were considered under control, treated persons with SBP&lt;140 mmhg and a DBP&lt;90 mmhg. A weighted binary logistic regression was used to assess associated factors with hypertension control. Input model variables were: sociodemographic variables, comorbidities and lifestyle factors.

Results

In this study, 8908 adults were enrolled with a mean age of 42.8±0.2 years old and a sex ratio (M/F) equal to 0.96. Among respondents, 29.3% (95% CI: 28.2-30.5) had hypertension, 60.7% (95% CI: 58.7-62.6) of them were unaware of their disease and only (29.5%, 95% CI: 28.2-30.5) of treated patients had a controlled hypertension. In multivariate analysis, eating more than five fruits and vegetables per day was independently associated with a better hypertension control (AOR=1.7, 95% CI: 1.1-2.5). In addition, participants living in northern Tunisia were more likely to have a controlled hypertension than those living in the south (AOR=1.9, 95% CI: 1.2-2.9).

Conclusions

Almost third of Tunisian adults were hypertensive. Low level of awareness and control of hypertension were found in this study. This highlights the urge to reinforce hypertension screening interventions and to strengthen educational programs on this disease with a focus on blood pressure monitoring and healthy lifestyle measures.

Key messages

Tunisian adults had a low level of awareness and control of hypertension. Reinforcing hypertension screening interventions and increasing awareness about healthy lifestyle measures are recommended.

Prevalence of seasonal Influenza vaccination among Tunisian elderly

Background

Surveys to determine the uptake of influenza vaccine (IV) among the at-risk groups are required to evaluate the advancement of national vaccination strategies and the level of awareness in the surveyed population. In this context, the present study aimed to estimate influenza vaccination uptake in elderly in Tunisia during 2018-2019 influenza season and to assess their perceptions toward influenza and IV.

Methods

It was a national cross-sectional study conducted in 2019 in primary and secondary health care facilities, among persons aged 60 years and over with chronic disease. Data were collected using a standard administered questionnaire including questions about IV uptake, general knowledge and attitudes about influenza and IV. Perceptions of participants toward general statements about influenza and IV were compared by vaccination status using chi square test.

Results

In total, 1191 older persons were included. Nearly one third of participants (34.8% [32.2-37.6]) were vaccinated at least once at the past and 19.4% [17.1-21.9] received the vaccine during 2018-2019 influenza season. Compared to unvaccinated elderly, vaccinated persons were significantly more convinced that influenza is more dangerous for elderly people (90.0% vs. 82.2%, p = 0.008), that IV is recommended for older persons (88.7% vs. 70.1%, p &lt; 0.001) and for those with chronic disease (86.1% vs. 64.1%, p &lt; 0.001) and that IV can protect elderly persons (87.9% vs. 71.9%, p &lt; 0.001) and those with chronic disease (88.3% vs. 66.3%, p &lt; 0.001). Regarding attitude about the safety of the vaccine, while 14.4% of unvaccinated persons agreed that IV is not safe for older persons, only 9.5% of vaccinated elderly approved that statement (p = 0.060).

Conclusions

Our study showed a low influenza vaccination rate among Tunisian elderly. In order to promote IV, campaigns should focus on educating elderly regarding the seriousness of influenza and the efficiency and the safety of IV.

Key messages

Efforts must be invested to improve influenza vaccination coverage among Tunisian elderly especially those with chronic diseases. Educating elderly regarding influenza and IV is necessary since knowledge is a basis for adopting relevant attitudes and practices.

[Dyslipidemia in uremic patients at the National Hospital of Donka-Conakry]

The prevalence of the dyslipidemia is higher at the patients in chronic renal failure (CRF) than in the general population. The objective of this study was to determine the prevalence and the lipidic anomalies among uraemic patients and to evaluate the others associated factors of cardiovascular risk. The study was descriptive with prospective recruitment (November 2004-June 2005); concerned 60 patients having an advanced chronic renal failure whose calculated clearance of creatinin was lower than 30 ml/mn as well as the hemodialysed patients. The lipidic disturbances on the whole 9/16 dialysed (56%) and 31 uraermia /44 were not dialysed (70%). This majority triglyceride dyslipidemia comprised 8 cases of hypertriglyceridemia in the group of dialysed patients against 19 in the group of not dialysed; 1 case of mixed hyperlipidemia against 6 cases and 4 cases of hypercholesterolemia HDL in the non dialysed group with 1 case of HDL low cholesterol. The patients with dyslipidemia were 4 females (25%) and 5 males (31%) among dialysed group; and of 13 female (29%) and 18 male (41%) among not dialysed. The average age was of 54.3 +/- 0.7 years for dialysed against the 46.6 +/- 0.2 years for the dyslipidémia in the non dialysed. Among others factors of cardiovascular risk, the arterial high blood pressure was noted at 9 dialysed patient's dyslipidémia and 20 case / 31 to the not dialysed dyslipidémia; and the diabetes was observed in 1 and 3 cases respectively. The addiction to smoking was noted in both groups except at the dialysis patients not dyalipidémiques.