L'influence de la COVID-19 sur la santé mentale des enseignants Tunisiens

Contexte

Au fur et à mesure que le virus du SARS-COV 2 se propageait, un climat de panique et de suspicion s'installait partout notamment pour les catégories à risque. Les effets délétères que pourrait avoir la maladie sur la santé mentale des enseignants sont possiblement sous-estimés. Cette étude visait à étudier l'association de la COVID-19 et l'atteinte mentale grave chez les enseignants Tunisiens.

Méthodes

Une étude transversale moyennant un auto-questionnaire était menée sur un échantillon représentatif des enseignants du niveau secondaire entre mars et avril 2021 à Sfax, Tunisie. La santé mentale était estimée par l’échelle de détresse psychologique (K6 de Kessler). Un seuil > 13 de cette échelle définit une atteinte mentale grave.

Résultats

Au total, 525 enseignants participaient à l'étude. Parmi eux, 292 étaient des femmes (55,6 %), soit un sexe-ratio de 0,8. L'âge médian était de 48 ans (intervalle interquartile=[41-53]). Quatre cent soixante-dix-huit cas (91 %) étaient mariés, 132 enseignants (25,1 %) avaient des maladies chroniques et 85 participants (16,2 %) étaient des fumeurs actifs. La prévalence de la COVID-19 était de 20 % (N=105). Le lavage régulier des mains était noté chez 438 enseignants (83,4 %). Le port régulier du masque était observé chez 427 enseignants (81,3 %). Deux cents enseignants avaient peur de perdre leur vie à cause de la maladie (38 %). La prévalence d'une atteinte mentale grave était de 59,8 % (N=314). Les facteurs indépendants d'une atteinte mentale grave étaient une infection COVID-19 antérieure (Odds ratio ajusté (ORA)=1,6 ; p=0,02), un antécédent de maladie chronique (ORA=2,1 ; p=0,01), la crainte de perdre leur vie par la maladie (ORA=2,3 ; p=0,007). Par ailleurs, le port régulier du masque (ORA=0,46 ; p=0,041) était un facteur indépendant associée à une moindre prévalence d'atteinte mentale grave.

Discussion/Conclusion

Les résultats de cette étude suggèrent que la COVID-19 avait maintes répercussions négatives sur la santé mentale des enseignants. De ce fait, leur accompagnement psychosocial demeure une obligation à planifier.

Déclaration de liens d'intérêts

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

Les effets indésirables des équipements de protection chez les professionnels de santé

Contexte

Les professionnels de santé (PDS) étaient obligés de porter les équipements de protection individuels (EPI) au cours de leur exercice en pandémie, afin de minimiser le risque de transmission du virus émergent. L'objectif de cette étude était de quantifier la prévalence de survenue des effets indésirables (EI) relatifs au port des EPI chez les PDS et d’étudier les facteurs qui lui sont associés.

Méthodes

Il s'agissait d'une étude transversale ayant inclus un échantillon représentatif de 300 PDS randomisés dans le CHU Hedi Chaker de Sfax, Tunisie, durant la période août-septembre 2021. Le recueil des données était réalisé par un questionnaire auto-administré anonyme.

Résultats

Au total, 218 sujets étaient de sexe féminin (72,7 %), l’âge moyen était de25,6 ± 3,49 ans. Selon la profession, 202 cas étaient des médecins (67,3 %) et 26 sujets avaient une ancienneté ≥ 10 ans (8,7 %). Les EI relatifs au port des EPI étaient notés chez 87 PDS, soit une prévalence de 57,2 %. L'analyse multivariée a montré que les facteurs indépendamment associés aux liés au port d'EPI chez les PDS étaient le sexe féminin (Odds Ratio Ajusté (ORA)=1,8 ; p=0,048), avoir des maladies chroniques (ORA=0,29 ; p=0,001) et avoir une infection antérieure par la COVID-19 (ORA=0,46 ; p=0,004). L'utilisation fréquente d'eau de Javel ou autre produit de désinfection sans protection et l'utilisation d'eau chaude en milieu de travail étaient indépendamment associées à un risque élevé d'effets indésirables ((ORA=2,22 ; p=0,003) et (ORA=2,83 ; p=0,005), respectivement). De même, la durée d'utilisation des EPI > 4 heures par jour (ORA=1,98 ; p=0,039), ainsi que l'utilisation de visières et/ou de lunettes en milieu de soins (ORA=1,84 ; p=0,045) étaient statistiquement plus associés à la survenue de EI chez les PDS.

Discussion/Conclusion

La prévalence des EI relatifs au port des EPI était importante. Des multiples facteurs lui étaient associés notamment professionnels. Des formations adéquates et répétitives destinés aux PDS portant sur le bon usage des EPI demeurent indispensables pour gérer ce problème.

Déclaration de liens d'intérêts

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

Ampleur de l'infection du SARS-COV2 chez les enseignants et son impact sur leur santé mentale

Introduction

Les épidémies engendrent un climat de panique et de suspicion qui se propage plus rapidement que l'agent pathogène lui-même. C'était le cas durant l'épidémie de COVID-19 notamment pour les catégories à risque. Les effets délétères que pourrait avoir la maladie sur la santé mentale des enseignants sont possiblement sous-estimés. Cette étude visait à estimer la prévalence de la maladie COVID-19 chez les enseignants et à étudier son association avec la détresse psychologique.

Matériels et méthodes

Il s'agissait d'une étude transversale moyennant un auto-questionnaire, menée sur un échantillon représentatif de 525 enseignants du niveau secondaire entre Mars et Avril 2021. La santé mentale était estimée par l'échelle de détresse psychologique (K6 de Kessler). Un seuil > 13 de cette échelle définit une atteinte mentale grave.

Résultats

Parmi les 525 enseignants participants à l'étude, 292 étaient des femmes (55,6 %), soit un sexe-ratio de 0,8. L'âge médian était de 48 ans (intervalle interquartile= [41-53]). Quatre-cent soixante-dix-huit cas (91 %) étaient mariés, 132 enseignants (25,1 %) avaient des maladies chroniques et 85 participants (16,2 %) étaient des fumeurs actifs. La notion de contage pour la COVID-19 était notée chez 184 cas (35 %). La prévalence de la maladie COVID-19 était de 20 % (N=105). Le lavage régulier des mains était noté chez 438 enseignants (83,4 %). Le port régulier du masque était observé chez 427 enseignants (81,3 %). Deux-cents enseignants avaient la peur de perdre leur vie à cause de la maladie (38 %). La prévalence d'une atteinte mentale grave était de 59,8 % (N= 314). Dans l'analyse multi-variée par régression logistique binaire, les facteurs indépendants d'une atteinte mentale grave étaient une infection COVID-19 antérieure (Odds ratio ajusté (ORA) =1,6 ; p=0,02), un antécédant de maladie chronique (ORA=2,1 ; p=0,01), la crainte de perdre leur vie par la maladie (ORA=2,3 ; p=0,007). Par ailleurs, le port régulier du masque (ORA=0,46 ; p=0,041) était un facteur indépendant associée à une moindre prévalence de maladie mentale grave.

Conclusion

L'état de santé mentale représente un problème majeur de santé publique pendant cette pandémie. Les résultats de cette étude suggèrent que la maladie COVID-19 avait maintes répercussions négatives sur la santé mentale des enseignants. De ce fait, leur accompagnement psychosocial devrait être pensé par les acteurs communautaires et sanitaires.

Aucun lien d'intérêt

Connaissances, attitudes et des pratiques des professionnels de santé vis-à-vis de la vaccination contre la COVID-19

Introduction

Devant la pandémie mondiale de COVID-19, un des seuls espoirs réside dans le développement d'un vaccin efficace. Les professionnels de santé (PDS) étant les plus exposés à cette maladie, ils sont les premiers à se faire vacciner. Cependant, la perception des PDS de ce vaccin n'était pas suffisamment évaluée. L'objectif de cette étude était d'étudier les connaissances, les attitudes et les pratiques face à la vaccination anti-COVID-19 chez les PDS.

Matériels et méthodes

Il s'agissait d'une étude observationnelle transversale ayant inclus un échantillon représentatif randomisé de 300 professionnels de santé dans un CHU durant la période de Mars-Avril 2021. Des scores préétablis sur 100 étaient utilisés pour évaluer les connaissances, les attitudes et les pratiques des PDS.

Résultats

Au total, 223 PDS étaient des femmes (74,3 %). L'âge moyen était de 29,5 ans ± 8,26. Selon la profession, 178 PDS étaient des médecins (59,3 %). Les valeurs moyennes /100 des scores des connaissances, des attitudes et des pratiques étaient de 54,32 ± 11,37, 83,34 ± 13,18 et de 75,91 ± 11,95, respectivement.

L'analyse multivariée par régression linéaire a révélé que les facteurs indépendants associés à la connaissance étaient la profession médicale (β=0,25 ; p<0,001) et le contact direct avec des patients testés COVID-19 positifs (β=0,136 ; p=0,015).

Pour les attitudes, l'urbanité de la résidence (β=(0,13) ; p=0,022), la profession médicale (β=0,29 ; p<0,001), le statut marié (β=0,12 ; p=0,025) et l'infection antérieure par la COVID-19 (β=(-0,14) ; p<0,001) étaient indépendamment assoicés au score de l'attitude.

L'ancienneté > 20 ans (β=0,152 ; p=0,008), le contact direct avec des patients testés positifs (β=0,112 ; p=0,049) ainsi que la profession médicale (β=0,165 ; p=0,004) étaient des facteurs indépendants prédictifs des pratiques vis-à vis la vaccination antiCOVID.

Conclusion

En dépit d'un score relativement faible des connaissances vis-à-vis de la vaccination anti-COVID, des scores élevés des attitudes et des pratiques étaient observés chez les PDS. Cette variabilité était expliquée par des facteurs socio-démographiques et professionnels qui incitaient cette population exposée constamment au risque professionnel d'infection à la vaccination afin d'assurer des soins sécurisés.

Aucun lien d'intérêt

Magnitude, risk factors of addictive behaviors among school students in Southern Tunisia

Background

The use of addictive product is an important public health problem rapidly spreading around the world threatening the users, their families and environments, causing serious health problems and devastating societies in psychological and economical terms. During adolescence, these substances are harmful to health, affecting the developing of brain. This study aimed at investigating the prevalence, the determinants and the impact of addictive behaviors (AB) among school students (SS).

Methods

This was a cross-sectional study including a three-stage randomized sample of 1210 SS from different public schools of Southern Tunisia, on April 2021, using an anonymous self-administered questionnaire. AB were defined as the consumption of at least one of the following products: tobacco, illicit drugs and alcohol.

Results

Overall, 723 SS were females (59.8%), with a sex ratio (Male/Female) of 2.3. The average age was 15.64±2.05 years. In total, 793 cases (65.5%) were from rural areas. The prevalence of addictive behaviors was 18.7% (225). It was 13.9% (168) for current smoking, 3.1% (37) for alcohol consumption and 1.7% (20) for illicit drug use. Factors independently associated with AB in logistic multivariate analysis were male gender (Adjusted Odds Ratio (AOR)=10.2;p&lt;0.001), secondary school studies (AOR=1.5;p=0.008), age ≥14 years (AOR=2.5;p&lt;0.01) and living alone or sharing home with friend (AOR=2.29;p=0.004). These AB had statistically negative impact on SS, notably for low school marks and academic failure (OR = 2.5;p=0.01 and OR = 1.66;p=0.002, respectively). Moreover, the perceived stress scale was statistically higher among SS with AB (OR = 1.4;p=0.03).

Conclusions

Addictive behaviors among SS were alarmingly prevalent in Southern Tunisia, which was correlated with socio-demographic, cultural and educational factors. New preventive and therapeutic strategies should be urgently initiated to ensure a safe educational and psychological environment for SS.

Key messages

Addictive behaviors among SS were alarmingly prevalent in Southern Tunisia. Addictive behaviors among SS were correlated with socio-demographic, cultural and educational factors.

Non-communicable diseases in Southern Tunisia: morbidity, mortality profile and chronological trends

Introduction

Non-communicable diseases (NCDs) represent a major public health problem worldwide. Giving their impact on the morbidity and mortality burden, understanding their chronological trends over time is a priority for epidemiological surveillance. We aimed to determine the epidemiological specificities of NCDs and to study their chronological trends over the period 2010-2015.

Methods

We retrospectively collected data of hospitalized patients from the regional registry of morbidity and mortality in the Southern University Hospital of Tunisia during the period 2010-2015.

Results

We included 18081 patients with NCDs aged ≥ 25 years, with an annual number of 3013 cases/year. The median age of patients was 60 years(Interquartile range IQR = [43-80 years)]). There were 10288 males(57%), with a sex ratio (male/female)of 1.3. The distribution of NCDs was characterized by the predominance of cardiovascular disease(CVD)(10346 cases, 57.2%), then cancers(3034 cases; 16.8%),diabetes(2489 cases; 13.8%) and chronic respiratory tract diseases(2212 cases; 12.2%). Chronological trends analysis of NCDs showed that they remained globally stable between 2010 and 2015. The same result was applied to the group of cancers, chronic respiratory diseases and diabetes mellitus. However, there was a sharp rise for CVD between 2010 and 2015(ρ = 0.84; p = 0.036). The proportion of CVD increased significantly among men(ρ = 0.87; p = 0.019) and elderly(ρ = 0.88; p = 0.019). During the study period, 234 deaths were due to NCDs, with hospital mortality and lethality rates of 5.2/1000 hospitalizations and 1.29%, respectively. CVD were the main cause of deaths(60%). The hospital mortality rate of NCDs increased significantly from 2010 to 2015(ρ = 0.85; p = 0.031), notably for CVDs(ρ = 0.94; p = 0.005).

Conclusions

Chronological trends analysis revealed a significant rise in the morbidity and mortality burden ofCVDs during the period 2010-2015. It is imperative, therefore, to strengthen health care for these patients.

Key messages

Non-communicable diseases. Morbidity and mortality.

Diabetes screening among School Teachers: Exploring the Ignored Dimension of School Health Program

Introduction

The rising prevalence of diabetes is a serious public health concern globally, with its complications and associated health expenditures. The school teachers have chronic stress, predisposing them to many chronic diseases. The aim of this survey was to assess the prevalence and the predisposing factors influencing diabetes among secondary school teachers.

Methods

A cross-sectional analytical study was carried out on a three-stage randomized sample of 258 secondary school teachers of 12 public schools on march 2021. A self-administered and pretested questionnaire was performed to assess sociodemographic characteristics and a Glucometer using glucose sticks was used to measure fasting blood sugar level. Diabetes and pre-diabetes were defined according to the International Diabetes Federation.

Results

Overall, 136 participants were females (52.7%) giving a male to female ratio of 0.9. The median age was 49 years (Interquartile range (IQR) = [43-53]). Of all teachers, 228 cases (88.4%) were married, 190 cases (73.6%) were from urban areas and 63 cases (24.4%) had a chronic disease. There were 29 (11.2%) active smokers. We noted that 23 participants were diabetics, giving a prevalence of fortuitous discovery diabetes of 8.9%. The prevalence of pre-diabetes was 10.5%. In multivariate logistic regression, higher prevalence of diabetes was independently associated with daily consumption of coffee (Adjusted odds ratio (AOR)=1.8; p = 0.048); frequently pasta consumption (&gt;3 times/week) (AOR=1.8; p = 0.012); family history of diabetes (AOR=2.5; p = 0.032), work seniority &gt;30 years (AOR= 2.2; p = 0.041) and higher body mass index (AOR=3.2; p = 0.02)

Conclusions

Our study results indicated that the prevalence of diabetes was relatively high among school teachers, addressing the urgent need for adopting healthy lifestyle. The School health program can be utilized as an effective tool to screen non-communicable diseases and to strengthen primary preventive care in school.

Key messages

Diabetes screening and associated factors. School teachers.

Predictors of hypertension self-care practice in primary health-care facilities of Sfax

Introduction

Unmanaged hypertension is usually accompanied with complications leading to disability in older adults. It has been demonstrated that self-care practice is essential for blood pressure control and reduction of hypertension complications. This study aimed to estimate the level of implementation of HTN self-care practice and to identify their associated factors in Sfax, Southern Tunisia.

Methods

It was a cross-sectional study conducted in Sfax, Southern Tunisia from March to April 2020. A total of 6 primary health care facilities was approached for the study participants according to a single-stage cluster sample, by selecting six grapes randomly. A total of 270 participants were recruited, among whom 250 cases (92.6%) completed the questionnaire. Statistical analysis was performed using SPSS.24.

Results

A total of 250 hypertensive patients were included in the study, giving a male to female ratio of 0.77. There were 125 participants (50%) aged over 65 years. Overall, 137 cases (54.8%) had a high total self-care practice score. The independent factors of good HTN self-care practice were age over 65 (AOR=9.5; p &lt; 0.001), university educational level of the participants (AOR=21.2; p &lt; 0.001), as well as receiving a health education, by healthcare providers (AOR=2.5; p = 0.012) and family members (AOR=4.36; p = 0.004). Advanced hypertension stage (II and III) (AOR=0.45; p = 0.032) and chronic pulmonary diseases, including asthma (AOR=0.42; p = 0.027) and COPD (AOR=0.27; p = 0.016) were independently associated with poor HTN self-care practice.

Conclusions

Advanced hypertension stage, pulmonary co-morbidities, education level and lack of self-care education were predictive factors of poor self-care practice. These findings suggested that such factors should be considered when planning hypertension self-care education

Key messages

Hypertension self-care practice. Hypertensive patients.

What are the predisposing factors of depressive disorders among school teachers?

Introduction

Teachers' psychological wellbeing is important for both teachers and student's development, but is highly stressful, particularly in special education. Chronic stress is associated with a range of mental health problems including risk of depression, which could lead to low quality of life and dropout. This research aimed to determine the prevalence of depression and their predisposing factors among school teachers.

Methods

A cross-sectional study was conducted on a randomized sample of 258 secondary school teachers in Sfax, Southern Tunisia on march 2021. The instrument used for depression measurement was adopted from the generalized anxiety disorder assessment (GAD-7).

Results

Among 258 school teachers, 136 were females (52.7%). The mean age was 47.5±8.1. Overall, 47 teachers (18.2%) had a work seniority above 30 years. According to the work conditions, 118 cases (45.7%) had problems with their students, 30 cases (11.6%) had problems with parents and 10 subjects (4%) had conflicts with their colleagues. The prevalence of depression was 44.6%. Moderate and severe depression were respectively noted in 72 (27.9%) and 43 (16.7%) teachers. In multivariate logistic regression, female gender (Adjusted odds ratio (AOR)=2.1; p = 0.004), history of chronic disease (AOR= 2.6; p = 0.001), working outside the family's region of residence (AOR= 1.8; p = 0.048), active smoking (AOR= 1.9; p = 0.042) and having problems with students at school (AOR=2.2; p = 0.039) were independently associated with higher prevalence of depression.

Conclusions

The prevalence of self-reported depression among school teachers was notably high, which may hamper their relationships and effectiveness with students. The most prominent risk factors were related to unhealthy lifestyle and lack of social support with students. Therefore, managing work conditions and establishing appropriate consulting and supporting programs are urgently required.

Key messages

Depression disorders. School teachers.

Depression in quarantined patients during the COVID-19 pandemic

Introduction

Quarantine for suspected patients of being infected by the COVID-19 can lead to negative consequences for mental health and the appearance of depressive symptoms.

Objectives

To assess the prevalence of depression in quarantined patients, and to analyze the associated factors.

Methods

This was a descriptive and analytical survey, carried out from April 4 to May 30, 2020, with 149 patients consulting the COVID-19 sorting box at the Hedi Chaker CHU in Sfax. Suspected COVID-19 patients were contacted by phone during their quarantine and invited to participate in our study. The Patient Health Questionnaire (PHQ-9) scale was used to assess the severity of depression. Cutoffs of 5, 10, 15, and 20 represent minimal, mild, moderate, moderately severe, and severe levels of depression based on PHQ-9 scores. A cutoff score of 10 determines major depression.

Results

The results showed a prevalence of major depression of 10.7%. Of all patients, 89.3% had minimal to mild depression; 10% had moderate to moderately severe depression and 0.7% had severe depression. The PHQ-9 score was statistically correlated with travel to a suspect area during the 14 days preceding the consultation (p = 0.008), contact with a subject confirmed COVID-19 (p = 0.01), previous follow-up in psychiatry (p = 0.047), the change of residence during quarantine (p = 0.045), the fear of transmitting the disease to relatives (p = 0.00) and the positive result of the nasopharyngeal swab (p = 0.00).

Conclusions

Psychological distress was felt in our patients. We recommend that necessary measures should be taken to combat depression.

Perceived stress among suspected patients during the COVID-19 outbreak in Tunisia

Introduction

Widespread outbreaks of infectious disease, such as COVID-19, are associated with psychological distress and symptoms of mental illness especially for patients with suggestive symptoms.

Objectives

Predict the prevalence of perceived stress and study associated factors among patients with suspected COVID-19 infection.

Methods

A cross sectional study was conducted between April and May 2020. Patients consulting the sorting box at the Hedi Chaker Hospital of Sfax and declared suspect to be infected by COVID-19 were invited to participate in our study after given their cosent. Perceived Stress Scale-10 was used to evaluate prevalence of perceived stress.

Results

In total, 149 participants participated. The mean age was 38.8±15.39 years. Medical or surgical history and psychiatric history were identified respectively in 30,2% and 12.1% of participants. Among all respondents, 74.5% took a nasopharyngeal swab to look for COVID-19 and only 6.4% had a positive test. Close contact with someone with a positive COVID-19 infection was found in 8.05%. Several participants (79,2%) expressed fear of transmitting the disease to their family members. The mean of the PSS-10 score was 11.97±9.83. Moderate to severe perceived stress was found in 44.3% of patients. Significantly higher scores were observed among participants with a positive pharyngeal swab for COVID-19 as well as those who perceived worry of transmetting the disease. No significant differences in perceived stress’ scores according to socio-demographic data.

Conclusions

Perceived stress was high among patients with suspected COVID-19 infection. Perceiving worry of transmetting the disease and having a positive pharyngeal swab for COVID-19 were the principal risk factors.

Disclosure

No significant relationships.

Prevalence and predictors of hypertension self-care practice in primary health-care facilities in Southern Tunisia

BACKGROUND

Unmanaged hypertension (HTN) is usually accompanied with complications leading to disability in older adults. It has been demonstrated that self-care practice is essential for blood pressure control and reduction of HTN complications.

OBJECTIVE OF THE STUDY

This study aimed to estimate the level of implementation of HTN self-care practice and to identify their associated factors.

STUDY DESIGN

It was a cross-sectional study conducted in Sfax, Southern Tunisia in April 2020.

MATERIALS AND METHODS

A total of 6 primary health-care facilities were approached for the study participants according to a single-stage cluster sample, by selecting six grapes randomly. A total of 270 participants were recruited, among whom 250 cases (92.6%) completed the questionnaire.

RESULTS

A total of 250 hypertensive patients were included in the study, giving a male to female ratio of 0.77. There were 125 participants (50%) aged over 65years. Overall, 137 cases (54.8%) had a high total self-care practice score. The independent factors of good HTN self-care practice were≥65years [Adjusted odds ratio (AOR)=9.5; P<0.001], university educational level of the participants (AOR=21.2; P<0.001), as well as receiving a health education, by health-care providers (AOR=2.5; P=0.012) and family members (AOR=4.36; P=0.004). Advanced hypertension stage (II and III) (AOR=0.45; P=0.032) and chronic pulmonary diseases, including asthma (AOR=0.42; P=0.027) and chronic obstructive pulmonary diseases (AOR=0.27; P=0.016) were independently associated with poor HTN self-care practice.

CONCLUSION

Advanced hypertension stage, pulmonary co-morbidities, education level and lack of self-care education were predictive factors of poor self-care practice. These findings suggested that such factors should be considered when planning HTN self-care education.

[Virus and Atypical Pathogens Detected in Community-Acquired Lower Respiratory Tract Infection in Infants and Children of Sfax Region, Tunisia]

Little is known about viral and atypical bacteria pathogen spectra of community-acquired lower respiratory tract infection in children in Tunisia. Thus, a prospective study was carried out between January 2009 and March 2010 in Sfax. Nasopharyngeal aspirates collected from 368 patients (78 with pneumonia and 290 with acute bronchiolitis) were analyzed by indirect immunofluorescence assay and PCR to detect influenza viruses, parainfluenza viruses, respiratory syncytial virus (RSV), human metapneumovirus, human rhinovirus, human enterovirus, adenovirus, coronavirus, Mycoplasma pneumonia (Mpn) and Chlamydia pneumonia (Cpn). One or more etiology was documented in 319 cases (86.7%). The most detected viruses were RSV (42.7%), rhinovirus (32.9%) and adenovirus (28.5%). Co-detection of two or three pathogens was found in 40% of positive samples. This study highlights the importance of respiratory viruses in lower respiratory tract infection in children of Sfax region as well as the high rate of co-detection of multiple viruses, resulting in challenges in clinical interpretation.

[Active smoking: A major risk factor for human non-communicable diseases in a hospital survey]

INTRODUCTION

Tobacco is the main preventable cause of death worldwide. Our study aimed to determine the role of tobacco in the occurrence of non-communicable diseases (NCDs).

METHODS

We conducted a retrospective study including all NCDs patients during 2015-2016. NCDs include cardiovascular diseases (CVD), chronic respiratory diseases (CRD), cancers (CS) and diabetes mellitus (DM).

RESULTS

We identified 3643 cases of NCDs (43%) among 8478 hospitalizations, all diseases combined. Active smoking was found in 1076 cases (29.5%). Among the NCDs groups, CVD was the most common (65%). Tobacco was significantly associated with CVD (P<0.001), CRD (P=0.002), bronchopulmonary CS (P<0.001), haematological malignancy (P=0.023), and DM (P<0.001). Multivariate analysis performing binary logistic regression revealed that tobacco was an independent factor associated with CVD (OR=2.6, P<0.001), CRD (OR=1.5, P<0.001), bronchopulmonary CS (OR=1.8, P=0.013) and DM (OR=3.6, P<0.001).

CONCLUSION

Active smoking was a major risk factor in the occurrence of NCDs. Thus, smoking cessation represents the cornerstone for preventing the spread of these diseases, especially in countries with limited resources.

[Medication adherence of a sample of hypertensive patients in the region of Sfax (Tunisia)]

THE AIM OF THE STUDY

Medication noncompliance is one of the daily problems of the physician. Improving the medication adherence allows better management of hypertension. The aim of this work was to determine the level of compliance for patients with hypertension and to identify factors that determine compliance.

METHODS

A cross-sectional study was carried out among a sample of hypertensive patients attending general and specialist practitioners in public or private clinics of Sfax. Two hundred and seventy-three participants had accepted to be interviewed. Patients were identified as noncompliants using a questionnaire developed by the Comité de lutte contre l'hypertension artérielle (CFLHTA).

RESULTS

Non-compliance rate was 63.4%. The low level of education was associated with a lower adherence. The monotherapy, the once-daily regimen with fewer number of tablets were associated with a better adherence (p<10(-6)). The welcome and the availability of drugs in the public clinic affect positively the adherence of patients (p<0.0002). A patient very satisfied with his consultation and the explanation given by the doctor about his illness and its treatment had a better adherence (p<0.00003).

CONCLUSION

Our study had demonstrated a low compliance with antihypertensive drug therapy. Tunisian health care system should elaborate a management plan which takes into account our particular predictors of compliance to improve adherence to antihypertensive medication.

Metformin effects on clomifene-induced ovulation in the polycystic ovary syndrome

BACKGROUND

Polycystic ovary syndrome (PCOS) is a common, complex endocrine disorder for women on reproductive age. A high incidence of ovulation failure is observed in PCO women and perhaps linked to insulin resistance related to metabolic features In the last few years some studies assessed hyperinsulinimea and insulin resistance attenuation effects, by insulin sensitizing agents such as metformin, in PCOS women suggesting potential scope for these drugs in CC ovulation induction quality improvement.

AIM

Our prospective study aim is to compare the effectiveness of clomifene citrate plus metformin and clomifene citrate plus placebo in women with newly diagnosed polycystic ovary syndrome.

METHODS

From February 24 to September 29 (2007), PCOS was explored on women attending the Department of Obstetrics & Gynaecology sterility consultation unit (CHU Hedi Chaker-Sfax) according to the Rotterdam 2003 diagnostic criteria. PCOS patients were randomized to receive, in addition to clomifene citrate treatment, placebo or metformin 850 mg two times a day all ovulatory cycle for three trials maximum. Ovulation detection was done by the E2 serum measurements and ovarian transvaginal ultrasonography' evolution controlling on 7th, 11th and 13th day of the cycle.

RESULTS

Within 7 months, 32 PCOS women were recruited in the study and equally allocated to the two groups. Baseline characteristics were similar in metformin group and placebo one. Ovulation was characterized by the presence of at least one mature follicle (> 16 mm), a circulating estradiol concentration in the edge of 150-250 pg and accessory an endometrial depth > 8 mm. The ovulation rate in the metformin group was 62.5% compared with 37.5% in the placebo group, a non-statistically significant (small study population) but important difference (1.66 times). Analyses show a higher mature follicle number and estradiol concentration in metformin group than in the placebo one. Metformin effect was, in our study, his only insulinosensitizer property consequence far away a 'making thinner' or Hyperandrogenism reducing ones.

CONCLUSION

The ovulatory response to clomifene can be increased in polycystic ovary syndrome women by decreasing insulin secretion with metformin.

INVESTIGATION OF THE MICROCIRCULATION AND THE STATE OF OXIDATIVE STRESS IN THE RAT AFTER SCORPION ENVENOMATION

1. Severe cases of scorpion envenomation (SE) generally show both respiratory and cardiocirculatory dysfunction. However, the pathophysiology of SE remains controversial. In the present study, we tried to explain the pathophysiology of the haemodynamic perturbations and cardiac failure in rats poisoned by the venom of Buthus occitanus tunetanus through a histomorphometric study of myocardial and muscular skeletal microcirculation and analysis of the oxidative stress state in order to evaluate the implication of the inflammatory process in the pathogenesis of SE. 2. Experiments were performed on 96 rats divided into 16 groups (n = 6 in each group). Two groups were used to determine the optimum conditions of venom administration and times when to measure haemodynamic parameters. The B. occitanus tunetanus venom was administered at a dose of 800 microg/kg and tissues were removed 5 and 20 min after envenomation. Six groups were used for histomorphometric study: two control groups, two poisoned groups an two melatonin-pretreated and poisoned groups. The histomorphometric study was performed on isolated hearts and skeletal muscles. The final eight groups of rats (two control groups, two envenomated groups, two control groups pretreated with melatonin and two groups pretreated and envenomated) were used to investigate the state of tissue oxidative stress during SE and to evaluate the anti-oxidant effect of melatonin on rats poisoned with B. occitanus tunetanus venom. This study was based on the determination of tissue malondialdehyde in isolated organs as an indicator of thiobarbituric acid-reactive substances (TBARS). Melatonin was injected at a dose of 5 mg/kg, i.v., 15 min before the administration of serum or venom. Data were compared using analysis of variance and Tukey's test for multiple pair-wise comparisons. 3. Five minutes after venom injection, a significant reduction in the mean relative volume of venules and arterioles in the heart and skeletal muscles of poisoned rats was noted. Twenty minutes after venom injection, these volumes were significantly increased in the heart and skeletal muscles of poisoned rats. Pretreatment of envenomated rats with melatonin resulted in a significant decrease in the mean relative volume of the venules and arterioles in the heart and skeletal muscles 5 and 20 min after venom injection compared with untreated envenomated rats. Investigation of the oxidative stress state showed a highly significant increase in TBARS in poisoned rats compared with control groups 5 and 20 min after venom injection. Melatonin pretreatment of rats poisoned with B. occitanus tunetanus venom resulted in an important and highly significant reduction of TBARS compared with untreated envenomated rats. 4. It appears from the results of the present study that administration of B. occitanus tunetanus venom engendered an excessive myocardial and skeletal muscular vasoconstriction attributed to massive catecholamine release followed by arteriolar and venular vasodilatation. This venous stasis at the muscular microcirculation could be due to myocardiac failure. However, the concomitant presence of arteriolar vasodilatation suggests an inflammatory process in the pathophysiology of SE. This process was suggested by the genesis of a state of oxidative stress in relation to the important lipoperoxidation, which was inhibited by administration of the anti-oxidant melatonin. Thus, melatonin pretreatment seemed to accentuate the first phase of vascular reactivity in envenomed rats and inhibit the second vasodilator phase observed 20 min after administration of the venom.

[Validity and reliability of Spinal Mouse to assess lumbar flexion]

OBJECTIVES

To evaluate the validity and reliability of the Spinal Mouse model to assess lumbar spine flexion.

MATERIAL AND METHODS

For the validity study, patients with low-back pain underwent radiography to produce 2 lateral radiographs, first from the neutral position, and then with full trunk flexion. The correlation between mobility as assessed by radiography and the Spinal Mouse were evaluated by use of Spearman's correlation coefficient (SCC) for segmental mobility (L1-L2, L2-L3, L3-L4, L4-L5 and L5-S1) and global mobility (L1-L5 and L1-S1). Reliability was studied in healthy volunteers by the intraclass correlation coefficient (ICC).

RESULTS

A total of 20 patients (8 women) aged 41.6+/-8.6 (range 24-63), were included in the validity study. The SCC between radiography and Spinal Mouse measures were 0.55; 0.64; 0.69; 0.54; 0.19; 0.7; and 0.86 for flexion mobility of the L1-L2, L2-L3, L3-L4, L4-L5, L5-S1, L1-L5 and L1-S1, respectively. A total of 45 subjects aged 24.2+/-3.7 (range 20-29) were included for the reliability study. For intrarater reliability, the ICC was 0.84; 0.89; 0.96; 0.97; 0.63; 0.95 and 0.83 for the L1-L2, L2-L3, L3-L4, L4-L5, L5-S1, L5-S1, L1-L5 and L1-S1, respectively. For interrater reliability, the ICC was 0.75; 0.81; 0.79; 0.60; 0.83; 0.85, respectively.

CONCLUSION

The Spinal Mouse has acceptable metrological properties to assess segmental and global lumbar mobility during trunk flexion. Its metrological properties are not acceptable to assess mobility of L5-S1.

Bactériologie des méningites communautaires dans la région de Sfax, Tunisie (1993-2001)

OBJECTIVE

The aim of this study was to analyze the distribution of bacteria responsible for community-acquired meningitis and the pattern of resistance of common species.

DESIGN

All bacteriologically confirmed cases of community-acquired meningitis were recorded between 1993 and 2001.

RESULTS

Two hundred twenty-four cases of bacterial meningitis were recorded. The most frequent species were Haemophilus influenzae and Streptococcus pneumoniae followed by Neisseria meningitidis with respectively 37.1%, 32.1%, and 10.7% of cases. The yearly distribution of these bacteria did not show any epidemic peak. Enterobacteria and group B Streptococcus were the most frequently identified pathogens in neonatal meningitis. H. influenzae was the predominant microorganism in children between one month and five years of age, (66.4%) followed by S. pneumoniae (23.5%). S. pneumoniae was the predominant bacteria responsible fore more than half of the cases over five years of age. 28.8% of H. influenzae strains produced beta-lactamase. 27.2% of S. pneumoniae strains were less susceptible to penicillin. Resistance rates for amoxicillin and cefotaxime were respectively 10.6% and 7.5%. Only one strain of N. meningitidis (4.2%) presented with a decreased susceptibility to penicillin.

CONCLUSIONS

In our study, H. influenzae and S. pneumoniae were the main microorganisms responsible for community-acquired meningitis. High resistance rates were found for these bacteria: 28.8% of H. influenzae to ampicillin and 27.2% of S. pneumoniae to penicillin.

[Bacteriological profile of infectious endocarditis in the area of Sfax (Tunisia)]

We performed a study to analyze epidemiological characteristics and bacteriological profile of infectious endocarditis (I.E) in the area of Sfax (Tunisia). We analyzed, retrospectively, all cases of I.E, according to Duke Criteria, hospitalized in the CHU Hédi Chaker of Sfax between January 1997 and December 2000. Bacteriological investigation included blood culture, cardiac valve culture and serology. Seventy-two cases of I.E were diagnosed. The average of age was 32.3 years. 47.3% of the patients did not have cardiac disease, 25% had a valvular prosthesis, 20.8% a native valvulopathy and 6.9% a congenital cardiopathy. Antecedent of acute rheumatic fever was noted in 66% of I.E on native valvulopathy and in 55.5% of I.E on prosthesis. The mitral valve was involved in 39%, the aortic in 27.5% and the two in 26% of the cases. The origin of bacteremia was found or supposed in 55.5% of the cases and was commonly dental (33 % of EI). The bacteriological diagnosis was positive in 51 cases (70.8%). Staphylococci were isolated in 17 cases (23.6%), Streptococci in 17 cases (23.6%) and dominated by oral streptococci (12 cases). Chlamydial serology was positive in 8 cases (11.1%). Diagnosis of infectious endocarditis due to Chlamydia pneumoniae was confirmed in a case by genomic amplification (PCR) and in situ hybridization on the valve. Endocarditis in Tunisia remains frequent. It reaches with predilection the young person in particular with rheumatic heart diseases. The bacteriological profile remains dominated by Streptococci and the Staphylococci.

An infrared flash contemporaneous with the γ-rays of GRB 041219a

The explosion that results in a cosmic gamma-ray burst (GRB) is thought to produce emission from two physical processes: the central engine gives rise to the high-energy emission of the burst through internal shocking, and the subsequent interaction of the flow with the external environment produces long-wavelength afterglows. Although observations of afterglows continue to refine our understanding of GRB progenitors and relativistic shocks, gamma-ray observations alone have not yielded a clear picture of the origin of the prompt emission nor details of the central engine. Only one concurrent visible-light transient has been found and it was associated with emission from an external shock. Here we report the discovery of infrared emission contemporaneous with a GRB, beginning 7.2 minutes after the onset of GRB 041219a (ref. 8). We acquired 21 images during the active phase of the burst, yielding early multi-colour observations. Our analysis of the initial infrared pulse suggests an origin consistent with internal shocks.

[Life years lost and epidemiological transition in the Sfax region (Tunisia)]

OBJECTIVE

To assess the burden of disease in the Sfax region and identify the main diseases that are the cause of lost life years due to premature death.

METHODOLOGY

The calculation of lost life years due to premature death was conducted using the demographic mortality data for the region obtained from the National Institute of Statistics combined with data on the classification of the causes of death collected through a survey on these causes conducted through a random sample taken from half of the deaths in the region. As described by Murray and Lopez, years of life lost as a result of premature death represent the difference between the age of death and an age corresponding to life expectancy falling between 65 and 85 years.

RESULTS

Out of a total of 52,316 life years lost that were recorded 27,902 were in the male population and 24,414 in the female. The main diseases found in males which cause lost life years are accidents (24.9%), cardiovascular diseases (17.3%), communicable diseases (17%), respiratory diseases (10.8%), prenatal problems (59.5%), and cancer (7.5%). For women the main causes were cardiovascular diseases (26.5%), respiratory illness (15.5%), accidents (11.5%), communicable diseases (10.3%) and cancer (9.5%).

RECOMMENDATIONS

These results marking the epidemiological transition in the region should serve to steer decision-makers to better rationalize and plan for health care costs and expenditure.

[Percutaneous mitral commissurotomy. 5-year results]

Long-term results of percutaneous mitral commissurotomy were evaluated in 410 patients with mean age of 31 years (18 to 68 years). 48% of patients had mean thickened leaflets, 35% had calcified valves and 17% had flexible leaflets and subvalvular apparatus. Procedure was performed with a double balloon in 57% and with Inoue's balloon in 43% patients. A good immediate results was obtained in 77% of patients. A good result was defined as a mitral valve area > or = 1.5 cm2 without mitral regurgitation. Clinical follow-up concern 378 patients. The actuarial 5 years rate were 84% in our serie, without surgery or new percutaneous mitral commissurotomy and good functional results (NYHA class I or II) were 71%. Valvular anatomy, immediate results (mitral valve area), history of mitral commissurotomy, old patients, atrial fibrillation can influence strongly the results.

[Quality control in tumor marker values: methology, results and potential problems]

Ensuring the quality is one of the first preoccupations of every biologist. However, measuring the circulating tumor markers could be more vital especially that the result is decisive for the diagnostic and the therapeutic attitude. In this study, we report methods used for an internal and external < or = quality control < or = program applied in the immunology laboratory of Sfax university hospital for the dosage of tumor markers AFP, CEA and CA15-3. The results obtained are analysed comparatively with those reported in literature. Factors causing discrepancies in the results of tumor marker measurements are recalled.

[Prevalence of hemoglobin abnormalities in Kebili (Tunisian South)]

BACKGROUND

Hemoglobin abnormalities constitute a public health problem in many countries in the world. In Tunisia, these disorders were thought to affect only the North-western population. However, the existence of hemoglobinosis concentration in Kebily in south Tunisia has been suggested by previous work. In order to estimate their frequencies, we performed a screening of hemoglobin abnormalities in the North-Kebili region, to establish a prevention program of the homozygous forms.

METHODS

This screening concerned all 1st and 2nd grade primary school pupils in North Kebily. After a questionnaire, a blood sample was drawn from every child. Hemogram, sickling test, and hemoglobin electrophoresis at alkaline pH were performed for all children. Hemoglobin electrophoresis at acid pH and a specific hemoglobin A2 titration were performed for some children.

RESULTS

The study concerned 1,400 children, aged between 5 and 12 years, the mean age was 7 years and 7 months +/- 10 months. Consanguinity rate and coefficient were respectively 44% and 2249 x 10(5). Endogamy was very high. The global rate of hemoglobin abnormalities was 9.4%. Drepanocytosis with a rate of 4.9% was the most frequent, followed by beta thalassemia (3.1%) and C hemoglobinosis (1.6%). These abnormalities were unequally distributed; very frequent in some localities, they were quite absent in others.

CONCLUSIONS

This study revealed a hemoglobinosis concentration in Tunisia, which can be classified second after that of Beja in North-western Tunisia. The heterogeneous distribution of the hemoglobin abnormalities in North-Kebili region and the high consanguinity and endogamy rates constitute factors that promote homozygous and double heterozygous forms to arise and justify the elaboration of a preventive strategy.

[Ultrasonography of acute osteomyelitis of the long bones in children. Diagnostic and prognostic value]

Between 1991 and 1994, ultrasonography was used to investigate 90 consecutive children with acute osteomyelitis. Ultrasonographic findings were analyzed taking into account the time elapsed from first symptoms. Outcome in 47 children who were treated and followed for at least 6 months was also studied. Deep soft tissue swelling adjacent to the affected bone was found to be an early but nonspecific sign which persisted all along the course of the disease. Periosteal elevation smaller than 3 mm, secondary to exsudation or septic fluid, confirmed the disease in earliest stage and was the most frequent ultrasonographic sign in first three days of disease. Treated at that stage, total resolution was obtained in 66% of patients and stabilization, in 34% of cases, without any evolution toward chronicity. Acute osteomyelitis with subperiosteal abscess progressed toward stabilization in 66% of cases and toward chronic osteomyelitis in 8% of cases. 32% of subperiosteal abscess were ruptured; in such situation, progression to chronicity was observed in 26% of patients. Since ultrasonography has been used in our institution for the diagnosis of acute osteomyelitis, the rate of evolution to chronicity spectacularly dropped from 63% to 11%. The main advantage of ultrasonography is an earlier detection of subperiosteal collection that indicates surgical drainage without any delay.

[Bronchopulmonary dysplasia. Course over 3 years in 88 children born between 1984 and 1988]

BACKGROUND

The survival and outcome of infants with bronchopulmonary dysplasia (BD) depend on the patient's maturity, the severity of the BD and nutritional problems. This study evaluates the specific role of chronic pulmonary failure in the growth and development of infants recovering from BD.

POPULATION AND METHODS

88 infants admitted for BD from January 1984 to December 1988, having gestational age from 25 to 41 weeks 5 days (mean: 29) and birth weight from 680 to 3,400 g (mean: 1,195) were studied. All infants were given respiratory support for 6 to 914 days (mean 84) and oxygen therapy for 28 to 1,232 days (mean: 119). 29 infants were given corticosteroids for more than 1 month. The outcome of the 80 infants with gestational ages of less than 33 weeks was compared to that of 272 infants with the same gestational age but not suffering from BD on their 28th day. The infants in both groups were examined at 2 years of age and classified as: a) handicapped (neurologic deficit, IQ < 80, hearing loss, blindness, convulsions); b) doubtful (transitory neurology dysfunction); c) normal.

RESULTS

Of the 88 infants still living at the age of 28 days, 19 died before the age of 2 years: 16 of the 64 surviving infants who could be followed until the age of 2 years were classified as handicapped, 13 were considered doubtful and 35 were normal. The more significant risk factors for neurodevelopmental impairment were: a) the presence of porencephaly and/or ventricular dilatation on brain ultrasonography; b) head circumference < -2 SD at the end of hospital stay; c) oxygen therapy and hospitalization > 5-6 months. The group of infants with BD had a higher death rate (24% vs. 3.7 in the group without BD) and more frequent neurodevelopmental impairment at gestational ages of > 31-32 weeks.

CONCLUSIONS

BD is an extra risk for the survival and neurodevelopment of infants with gestational age > 31 weeks.