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PubMed1997

Prevalence of cardiovascular risk factors in the urban population of Soussa in Tunisia.

BACKGROUND: With the epidemiological transition phenomenon, Tunisia is now facing the growing prevalence of chronic diseases. Environmental and behavioural changes such as the adoption of new dietary habits and a sedentary lifestyle, and the stress of urbanization and of working conditions all lead to the rise in cardiovascular disease (CVD) risk factors. METHODS: The aim of this study is to estimate the prevalence of the main CVD risk factors in an urban context. For this, we have undertaken a household epidemiological survey of a representative sample of the adult urban population of Soussa, Tunisia (n = 957). RESULTS: This study shows high prevalences of hypertension (blood pressure >160/95 mmHg) of 18.8 per cent with an adjusted rate of 15.6 per cent, history of diabetes of 10.2 per cent, and obesity (body mass index > 30) of 27.7 per cent [significantly higher in women (34.4 per cent)], android obesity 36 per cent, smoking habits 21.5 per cent [significantly higher in men (61.4 per cent)]. CONCLUSION: With this profile of CVD risk factors, Tunisia must implement a national strategy of primary prevention and heart health promotion in addition to the efforts recently made in secondary prevention of some chronic diseases such as hypertension and diabetes.

Adult↗
PubMed2006

Genetic diversity of Acacia tortilis ssp. raddiana rhizobia in Tunisia assessed by 16S and 16S-23S rDNA genes analysis.

AIMS: In order to understand the genetic diversity of Acacia tortilis ssp. raddiana-rhizobia in Tunisia, isolates from nine geographical locations were obtained and analysed. METHODS AND RESULTS: Characterization using restriction fragment length polymorphism analysis (RFLP) of PCR-amplified 16S rRNA gene and the intergenic spacer (IGS) between the 16S and 23S rRNA genes was undertaken. Symbiotic efficiency of the strains was also estimated. Analysis of the 16S rRNA by PCR-RFLP showed that the isolates were phylogenetically related to Ensifer ssp., Rhizobium tropicii-IIA, and Rhizobium tumefaciens species. Analysis of 16S-23S spacer by PCR-RFLP showed a high diversity of these rhizobia and revealed eleven additional groups, which indicates that these strains are genetically very diverse. Full 16S rRNA gene-sequencing showed that the majority of strains form a new subdivion inside the genera Ensifer, with Ensifer meliloti being its nearest neighbour. Nodulation test performed on the plant host demonstrated differences in the infectivity among the strains. CONCLUSION: Rhizobial populations that nodulate specifically and efficiently Acacia tortilis ssp. raddiana in representative soils of Tunisia is dominated by E. meliloti-like genomospecies. SIGNIFICANCE AND IMPACT OF THE STUDY: This paper provides the first clear characterization and symbiotic efficiency data of rhizobia strains nodulating A. tortilis in Tunisia.

Acacia↗
PubMed1995

Ochratoxin A in human blood in relation to nephropathy in Tunisia.

The determination of ochratoxin A (OTA) in human blood in Tunisian populations is underway. The range of contamination is between 0.7 to 7.8 ng ml-1 for the general population and 12 to 55 ng ml-1 for people suffering from chronic renal failure. It appears that 21 to 64% of people suffering from nephropathy are OTA positive with a detection limit of 1ng ml-1. This situation prompted us to search for possible association of OTA contamination and nephropathy resembling Balkan endemic nephropathy. The classification of the ill population into chronic interstitial nephropathy (CIN), chronic glomerular nephropathy (CGN), chronic vascular nephropathy (CVN) and others, indicated that the largest is the CIN group which is significantly different from the other groups, and from the control (P < 0.005). Furthermore, it presented the highest OTA mean values (25 to 59 ng ml-1) compared with the control, CGN, CVN and other groups (6 to 18 ng ml-1) according to the designated region in Tunisia. The rural population seems to be more exposed to ochratoxins in Tunisia, as has been previously reported in the Balkans and Western Europe. Altogether, these results emphasise that in Tunisia an endemic ochratoxin-related nephropathy is probably occurring.

Adult↗
PubMed2001

Epidemiology of cardiovascular risk factors among schoolchildren in Sousse, Tunisia.

BACKGROUND: In Tunisia, where the epidemiological transition phenomenon is well established, there are no data available at the population level on the cardiovascular disease (CVD) risk profile for children, although it is well known that risk factor development takes place in childhood. METHODS: We report an epidemiological survey based on a representative sample of 1569 urban schoolchildren of Sousse in Tunisia to assess the following CVD risk factors: hypertension, hypercholesterolaemia and other lipid disorders, obesity and tobacco consumption. RESULTS: The main results showed that girls had significantly higher levels of body mass index (BMI), diastolic blood pressure (DBP), total cholesterol, low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol than boys, who however had significantly higher levels of systolic blood pressure (SBP). Total cholesterol was significantly correlated to BMI and decreased with age. Obesity (BMI = 27) was found in 7.9% of the study population and was significantly higher for girls (9.7%) than for boys (6%): chi 2 = 9.02, DF = 2, P = 0.011. Overweight (BMI = 25) was also significantly higher for girls (16%) than for boys (11.1%): chi 2 = 8.21, DF = 1, P = 0.0041. Smoking habit concerned 7.6% of the study population; it was significantly higher for boys (14.7%) than for girls (1.1%): chi 2 = 103.4, DF = 1, P < 0.00001. CONCLUSION: This study showed to some extent that Tunisia's urban population of schoolchildren is exposed early to CVD risk factors and all should be done to avoid the worsening of this profile. These results will serve as a baseline for assessment of future trends in the risk factors studied.

Adolescent↗
PubMed2000

Comparison of ribosomal ITS regions among Androctonus spp. sorpions (Scorpionida: Buthidae) from Tunisia.

Three species of scorpions have been reported from Tunisia: Androctonus amoreuxi Audoin, A. aeneas Koch, and A. australis L. The latest has been divided in two subspecies: A. australis garzonii Goyffon & Lamy and A. australis hector Koch. Despite the public health importance of these animals, which cause several cases of poisoning each year, nothing is know about the genetic diversity of the group. To gain a better understanding of the group, we studied the variation of rDNA sequences of the ITS1, 5.8S, and ITS2 region of 14 representatives of the four taxa in Tunisia. The main result is the high polymorphism of the ITS regions. In some instances in both intra- and interspecific comparisons, it was difficult to unambiguously align the sequences. However, some representatives of different species were relatively similar, so that it appeared difficult to recognize the species on the basis of these sequences. A phylogenetic analysis was conducted that inquires the validity of the subspecies status of A. australis garzonii and A. australis hector. Moreover, the taxonomic status of A. aeneas is also questioned. Our studies highlighted the need of a revision of the taxonomy of the scorpions in Tunisia; however, the use of other genetic markers will be necessary to solve this question.

Animals↗
PubMed2005

[Writings of the medical observers on the state of the health of Tunisia under the French Protectorate (1881-1956)].

From the military occupation of Tunisia by France in 1881 to that country's independence in 1956, several successive medical observers left behind a wealth of information on the state of health of hte populations composing the Tunisian mosaic. Even thought pre-colonial Tunisia has often been described as a land saddled with disasters and plagues, medical "topographers," most of whom were military doctors accompanying the French expeditionary corps, focused on the fact that few epidemics ever occurred in Tunisia at the time of the Regency. According to some of them, the health situation was better than in Algeria who had been a colony for half a century. The research conducted by the Institut Pasteur in Tunis and medical dissertations by hospital interns in the Regency's capital provide a second source of information comprising invaluable information about endemic infectious diseases. In the inter-war period, the social hygiene movement concentrated upon fighting tuberculosis and protecting infant and maternal health, shifting medical focus to social or "ordinary" diseases and their treatment. Prior to Tunisian independence, a third wave of studies conducted by the new university's socio-medical research group reinforced the connection between lifestyle and health.

Biomedical Research↗
PubMed1999

Tropical theileriosis in Tunisia: epidemiology and control.

In Tunisia, tropical theileriosis (Theileria annulata infection of cattle) is one of the major diseases affecting cattle in the summer. Each year about 2,500 clinical cases are recorded in the country, mainly in pure-bred animals. An attempt was made in the North of Tunisia to estimate the direct cost related to clinical cases of TT. In the endemic regions, three states of endemicity were described according to cattle age categories at highest disease risk: (i) endemic stability, (ii) low endemic instability, (iii) high endemic instability. The characterisation of these endemic situations, which are conditioned by the levels of the vector tick population and the quantitative aspects of the infection in ticks, are highly relevant for the development of a live attenuated cell line vaccine against TT targeting the cattle population at disease risk in Tunisia. A research programme was set up to develop the attenuation of four local parasite stocks. Two cell lines infected with two distinct T. annulata stocks were tested in the field on pure-bred animals of different age groups from regions with high disease incidence. The vaccination with each of the two cell lines showed a high efficacy. However significant differences in vaccine reactions rates were observed between the two attenuated cell lines emphasising the importance of achieving an optimal balance between protection and vaccine tolerance particularly in pure-bred lactating cows.

Animals↗
PubMed2000

[Epidemiology of cholelithiasis in central Tunisia. Prevalence and associated factors in a nonselected population].

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

Adult↗
PubMed2003

[Mucosal localization of leishmaniasis in Tunisia: 5 cases].

INTRODUCTION: Three epidemic-clinical forms of leishmaniasis are found in Tunisia: the sporadic cutaneous form due to L. Infantumin in the North, the zoonotic cutaneous form due to L. Major in the Center and South-West, and the chronic cutaneous form due to L. Tropica in the South. We report 5 cases of mucosal leishmaniasis diagnosed in a Dermatology unit in Tunis. OBSERVATIONS: Four women and one man, from the North-west of Tunisia, with a mean age of 42.4 years (range: 8-75 years) presented with leishmaniasis. The lesions were localized on the mucosa of the lips in 4 patients and on the endonasal mucosa with infiltration and nasal obstruction in a 75 year-old female patient. Diagnosis of leishmaniasis was established on direct examination in 4 cases and histological examination in 3 cases and by culture in NNN milieu for one patient exhibiting a MON5 L. Major leishmaniasis. All the patients responded well to treatment with intramuscular meglumine antimoniate (Glucantime). In our 5 patients, the mucosal involvement was not as mutilating, nor resistant to treatment, as that described for the cutaneous-mucosal forms in the New World. COMMENTS: Mucocutaneous leishmaniasis, endemic in Central and South America, are due to L. Braziliensis. They provoke mutilating and disfiguring lesions, resistant to treatment. In Tunisia, the forms of the disease observed are dermotropic, usually responsible for cutaneous leishmaniasis. However, mucosal involvement is not uncommon and is characterized by the absence of mutilating lesions and the excellent response to treatment.

Adolescent↗
PubMed2003

[Mycetomas in central Tunisia].

INTRODUCTION: Mycetomas are inflammatory pseudo-tumors containing fungal or actinomycosic-type grains. They are frequent in tropical and subtropical countries and unknown in Tunisia. PATIENTS AND METHODS: We conducted a retrospective study of 12 cases of mycetoma registered in the Dermatological department of the university hospital in Sousse (central Tunisia) over a period of 27 years, from 1974 to 2001. The diagnosis was confirmed by anatomopathological and/or mycological examination. RESULTS: The mean age at the onset was of 49 years and the sex ratio of 1. A notion of a traumatism was reported in two cases and eight patients had various agricultural activities. The mean duration of progression was of eight years. The localization was the foot in 10 cases. The mycetoma was of actinomycosic origin in 10 cases, due to Actinomadura madurae in nine cases, to Nocardia spp in one case and of fungal origin in 2 cases:Pseudoallescheria boydii in one case and Madurella mycetomi in the other. Antibiotic therapy was associated with surgical exeresis in nine cases and amputation in the other two cases. COMMENTS: Confrontation of our results with those of Tunisian series and a review of the literature, helped to specify the clinico-epidemiological characteristics and progression of mycetoma in Tunisia. These characteristics are: the rareness of the infection, the relative frequency of affection in women, the proximal involvement of the foot, the frequency of agricultural activity and the rareness of traumatic past history, the predominance of the actinomycosic origin due to Actinomadura madurae, and the need to associate surgical exeresis with the medical treatment or amputation in order to stop the progress of the disease.

Adult↗
PubMed2001

[Epidemiology and prevention of smoking in Tunisia: current situation and perspectives].

This paper describes the trends in tobacco sales and smoking prevalence in the Tunisian population, estimates the consequences of smoking on mortality of this population, and discusses anti-tobacco actions: educational actions, legislative measures and price increases. Sales Data were collected from the Tunisia tobacco company. Smoking prevalence data from surveys, conducted by several institutes, and numbers of deaths by causes have been estimated from WHO for the year 1998. Tobacco sales increased from 4.96 g per adult per day in 1981, to 6.3 g, in 1993, then decreased widely. The proportion of smokers was 30% in 1996. 55% among men versus 5.6% among women. Among 17 to 24 years old young adults, the proportion of smokers was 29.2% in 1994 (50% among men versus 3.9%, among women). Mortality attributable to tobacco in Tunisia has been estimated to 6430 deaths in 1997 (5580 among men versus 850 among women). These deaths represent 22% of the total male deaths and 4% of the female ones. Anti-tobacco measures have been reinforced by the enactment of anti-tobacco law. Proportion of young smokers remaining elevated, it is expected that consequences of the tobacco addiction in Tunisia, in term of mortality, will be even heavier in the next two decades, if efficient anti-tobacco actions are not implemented.

Adolescent↗
PubMed2003

[Clandestine slaughtering in Tunisia: investigation on the knowledge and practices of butchers concerning hydatidosis].

UNLABELLED: Echinococcosis is one of the major parasitic diseases in Tunisia, accounting for a considerable public health problem. We propose in this work to analyse the behaviour of butchers and to evaluate its impact on the hydatic cyst transmission. MATERIAL AND METHODS: We carried out a national transversal descriptive survey that included 97 butcher shops using illegal practice, located in 18 regions (governorats) of Tunisia. The sampling procedure was implemented according to the level of disease endemicity. RESULTS: 60.8% of butcher shops were located along main roads and therefore supplying travellers. Among the animals slaughtered sheep come in first position (97.9%). More than 80% of the butchers kept aside a place around the butcher shop to sacrifice their animals. We noted the presence of dogs near butcher shop in 52.6% of cases and stray dogs in 43.3% of cases. Only 13.4% of the butchers knew the disease mode of transmission. Parasitized viscera were thrown into dustbins or further in the riverbed in 56.7%. More than 50% of butchers, having an inadequate behaviour in front of parasitized viscera or ignoring the disease cycle, were originating from an hyper or holoendemic area. CONCLUSION: Illegal slaughtering practices have an important impact on transmission of cystic echinococcosis in Tunisia.

Animals↗
PubMedDate not supplied

[Prevalence and characterization of uropathogenic Escherichia coli producing cytotoxic necrotizing factor type 1 (CNF1) in the center of Tunisia].

During a three-year survey of the prevalence in central Tunisia of Escherichia coli producing CNF1 toxin (NTEC), 716 samples have been investigated by PCR for cnf1 gene. All samples were isolated from urine of adult and children patients presenting significant bacteriuria (> 10(5) colony-forming units/mL), independently of the severity of the clinical presentation; 328 strains were found harboring cnf1 gene, they were distributed into three clinical categories: 219 (66.76%) from patients with symptomatic bacteriuria, 76 (23.17%) from patients with uncomplicated cystitis and 33 (10.06%) from patients with acute pyelonephritis and complicated urinary tract infections. 98.78% (324) of CNF1 strains presented hemolytic activity. All 328 CNF1 strains harbored both sfa and pap genes and expressed MRHA activity. They belonged to 16 different serotypes. The most common serotypes, in order of frequency, were O6 (25.91%), O4 (17.98%), O2 (12.5%), O75 (9.14%), O78 (8.35%), and O83 (3.65%). Two strains (0.6%) were O168; a serotype shown to be associated to CNF2 producing bovine strains. The frequency of uropathogenic CNF1 strains in center Tunisia was about 45.81% and increased from 26.08% in 1998 to 58.16% in 2000. We showed that E. coli producing cytotoxic necrotizing factor (CNF1) was implicated in urinary tract infections in center Tunisia but no difference was shown between strains isolated from patients with complicated or uncomplicated urinary tract infections. The presence of CNF1 toxin with various associated virulence factors seemed to increase the risk for severe forms of urinary tract infections.

Adult↗
PubMed2005

The challenge of preventing cardiovascular disease in Tunisia.

Chronic disease, and particularly cardiovascular disease (CVD), is the major cause of death in most developed countries, despite the downward trend observed during the last three decades. Although CVD is emerging in developing countries, little is known there about comprehensive preventive measures for controlling its expansion. The health care system in Tunisia faces the challenge of increasing rates of CVD risk factors. Epidemiologic studies show high levels of CVD risk factors among Tunisian adults and children. Evidence shows that several risk factors and conditions are commonly associated with major chronic diseases. Integrated actions against selected risk factors (i.e., smoking, physical inactivity, and unhealthy diet), implemented within the social context, can lead to the reduction of major chronic diseases. These interventions should take place early in childhood. In Tunisia, a much-needed community-based intervention program to control CVD is being planned. This program will promote healthy living, smoke-free air, healthy nutrition, regular physical activity, and supportive living and working environments. Its ultimate goal is to reduce the burden of CVD and its related behaviors. A description of this program and how it will be implemented and assessed in the region of Sousse, Tunisia, is presented.

Adult↗
PubMed2006

Association among education level, occupation status, and consanguinity in Tunisia and Croatia.

AIM: To investigate the association between education level, occupation status (a proxy for socio-economic status), and consanguinity in 2 large data sets from Tunisia and Croatia countries with different attitudes toward consanguinity. METHODS: The sample of 1016 students, attending 5 university institutions in Monastir, Tunisia, were interviewed about the educational level and occupation status of their parents and the degree of parental relatedness. In Croatia, a sample of 1001 examinees from 9 isolated island populations was interviewed about their own educational level, occupation status, and consanguinity. RESULTS: Prevalence of consanguinity (offspring of second cousins or closer) among 1016 Tunisian students was 20.1%, and 9.3% among 1001 Croatian isolates. In Tunisia, the association between consanguinity and both parental degree of education and parental occupation status was highly significant in women (P<0.001), but not significant in men. In Croatia, no statistically significant associations were noted, although there was a consistent trend of increased prevalence of consanguinity with lower education level or occupation status in both genders, but more pronounced in women. CONCLUSION: Association between education level, socio-economic status, and consanguinity needs to be taken into account in inbreeding studies in human populations. The relationship may be specific for each studied population and highly dependent on the cultural context. It is generally more pronounced among women in most settings.

Adolescent↗
PubMed1990

[Development of infestation with Varroa jacobsoni O. in bee colonies in Tunisia].

The mite Varroa jacobsoni, an ectoparasite of the honey bee, was imported to Tunisia probably in 1976. Afterwards, this parasitosis caused severe losses of colonies for several years. The continued examination of the level of infestation in colonies of a "GTZ" project stated a steady number of mites since 1980. Only in a few colonies, the infestation was above the limit of damage. Though the colonies in North West Tunisia did not receive any treatment since 1986 there was no increase of infestation. In order to investigate the reason for this the mites' ability of reproduction was examined during two following years. The portion of infertile female mites in the worker brood in most of the colonies was with 50% considerably higher than in Europe. In Brazil, the adaptation between host and mite produced similar low reproduction rates. As, however, in Tunisia the portion of infertile females in the drone brood of the individual colonies corresponded to the one in the worker brood climatic conditions are supposed to be responsible.

Animals↗
PubMed1994

[Breast self-examination practice in Tunisia based on a survey of first-line patients].

As the first phase of a breast cancer screening campaign in central Tunisia, a survey aimed at evaluating the frequency of self-examination of the breasts (SEB) and identifying factors which might influence this practice took place in the Kalâa Kbira region of Tunisia, involving 300 first-line out-patients. Women answered a questionnaire presented by a resident in medicine during the course of the visit. The survey showed that the use of SEB remains slight (28%). Discriminant analysis enabled identification of parameters influencing this practice. Thus age of the patient, educational level of the woman and/or spouse and the source of information were the most significant parameters, in increasing order of importance. The results of this survey should enable definition of the content and form of information to be given to women in order to obtain their participation in a breast cancer screening campaign in central Tunisia.

Adult↗
PubMed1993

High prevalence of the point mutation in exon 6 of the xeroderma pigmentosum group A-complementing (XPAC) gene in xeroderma pigmentosum group A patients in Tunisia.

Xeroderma pigmentosum (XP) patients in Tunisia who belong to the genetic complementation group A (XPA) have milder skin symptoms than do Japanese XPA patients. Such difference in the clinical features might be caused by the difference in the site of mutation in the XP A-complementing (XPAC) gene. The purpose of this study is to identify the genetic alterations in the XPAC gene in the Tunisian XPA patients and to investigate the relationship between the clinical symptoms and the genetic alterations. Three sites of mutation in the XPAC gene have been identified in the Japanese XPA patients, and about 85% of them have a G-->C point mutation at the splicing acceptor site of intron 3. We found that six (86%) of seven Tunisian XPA patients had a nonsense mutation in codon 228 in exon 6, because of a CGA-->TGA point mutation, which can be detected by the HphI RFLP. This type of mutation is the same as those found in two Japanese XPA patients with mild clinical symptoms. Milder skin symptoms in the XPA patients in Tunisia than in those in Japan, despite mostly sunny weather and the unsatisfactory sun protection in Tunisia, should be due to the difference in the mutation site.

Adolescent↗