[Health organization in Tunisia at the point of the creation of the Pasteur Institute in Tunisia].
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Academies and Institutes↗
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[Myxomatosis in Tunisia: seroepidemiological study in the Monastir region (Tunisia)].
A sero-epidemiological study of myxomatosis, realized in the region of Monastir, confirmed the existence and the prevalence of the disease in its nodular form. Different strains of the myxomatosis virus were isolated and identified by gel immunodiffusion test (GID) using specific polyclonal sera. Serological analyses using complement fixation (FC) and (GID) tests allowed the detection of specific antibodies in sera from both healthy and sick animals. The results also confirmed the better sensitivity of the FC over the GID. Overall rates infection of herds and animals were 54.9% and 32.63% (p < 0.05), respectively, as revealed by serological testing. These rates increase with the size of herds. Geographic distribution of myxomatosis cases suggests that the disease first appeared in the coastal region then moved inside the Sabel area. Breeding and farming conditions, associated with deficiency in sanitary and medical measures, are at the origin of the introduction and the wide distribution of myxomatosis in this region.
Animals↗
[Messages of professors Robert Debré and Gilbert Dreyfus addressed in 1952 to their colleagues in Tunisia in the occasion of the Fiftieth anniversary of the Society of Medical Sciences of Tunisia].
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Correspondence as Topic↗
Tunisia with Hope. An opportunity to serve in Tunisia on the Ship Hope.
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Dentists↗
Tunisia WFS [World Fertility Survey].
Tunisia, the smallest North African country in size, has recently published the results of its part of the World Fertility Survey (WFS) taken in 1978. About 1/2 of this Missouri-sized country consists of arid and semiarid desert, with well-irrigated fertile areas in the north. The country, which has a population of about 7 million, must import large quantities of food each year and also suffers from widespread unemployment. In 1964, the government was among the earliest to announce a policy to reduce the rate of population growth and Tunisia now has 1 of the lowest birth rates of the African continent (33 births/1000 population) although it is still moderately high. Part of the reason for the birth rate decline has been a risking age at marriage; the legal minimum was fixed at 17 years for women and 20 for men by a 1964 law. The Tunisia WFS indicates that, of women 20-24 in 1978, 56% had not yet married, a large increase from the 27% of 1966. The mean age at 1st marriage for females was 24 in 1978, very high by less developed country standards. It may be that the fertility-lowering impetus from rising age at marriage has been spent (this measure cannot rise indefinitely): Tunisia's total fertility rate (TFR), the average number of children/woman, dropped from 7.1 children in 1966 to 5.7 in 1976, but the decrease has tapered off somewhat since. The TFR appears to have dropped to 5.2 as of 1981. When asked how many children they would like to have, the women surveyed gave 4.2 children, on average, as their "ideal" number. This number is, of course, considerably above that needed to ultimately stop population growth (about 2.1-2.5 children/woman). Contraceptive use in Tunisia is quite high by developing country standards; much of this is due to the efficient network of government-sponsored clinics. About 44% of the women exposed to pregnancy were practicing an efficient form of family planning with the pill or sterilization accounting for most of that number (22 and 20% respectively). Nonetheless, traditions which still favor 3-5 children and some possible loss of momentum from a rising age at marriage may cause future fertility declines to be slower than in the recent past. Tunisia does present an interesting case of a country maintaining a government program to reduce population growth as an overall part of the country's development efforts.
Africa↗
[Probable origin of the Robertsonian phenomena in domestic mice in Tunisia].
The Robertsonian phenomenon in house mice (Mus musculus domesticus) from Tunisia consists in the presence of only one 22-chromosome Robertsonian race (22Rb) carrying the maximum number of fusions observed until now. The 22Rb populations exclusively occupy urban centers in the Eastern-Central region of Tunisia where standard population with 40-all acrocentric chromosomes (40Std) occur in surrounding neighborhoods and rural environments. In addition to the habitat partition, allozyme and mitochondrial DNA analyses showed that the 22Rb populations were genetically differentiated from the 40Std ones. This differentiation mostly stemmed from an important decrease in genetic variability in the 22Rb populations from the Sahel towns. The extent of morphological, ecological and genetical divergence observed between these chromosomal races in Tunisia is in agreement with the predictions of the chromosomal speciation model of White which advocates that karyotypic differentiation between taxa can lead to their reproductive isolation and independent evolution. Such a process is verified if the Rb process in Tunisia results from local differentiation which is supported by both the genetic and morphological data. However, the hypothesis of an origin by introduction of these mice from another region of Tunisia or from another country cannot be totally dismissed. In this study, an allozymic analysis of mice (22Rb and 40Std) from the geographically distant city of Kairouan was performed. Results showed that 22Rb and 40Std mice from Kairouan shared the same high degree of variability, and were not genetically differentiated. This contrasts with the results registered in the two chromosomal races in the Sahel towns. Such data argue in favor of a local differentiation of the Robertsonian process in Tunisia and suggest that the decrease in variability of the structural nuclear genes in the Sahel 22Rb populations can be related to an introduction from Kairouan into a Sahel locality resulting in a founder effect or followed by a severe bottleneck prior to its dispersion throughout the Sahel region.
Animals↗
Hepatitis A in Tunisia: phylogenetic analysis of hepatitis A virus from 2001 to 2004.
Tunisia is a highly endemic area for hepatitis A virus (HAV) infection. In the present study, the phylogenetic characterization of the VP1 gene (882 nucleotides) and of the VP1/2A junction (336 nucleotides) of Tunisian strains were examined. One hundred strains isolated from patient with anti-HAV IgM from 2001 to 2004 were amplified by RT-PCR, sequenced at the VP1 and at the VP1/2A junction and aligned with the published sequences to establish phylogenetic analysis. All Tunisian strains belong to genotype I with a greater presence of sub-genotype IA (98%) originate from most of Tunisian regions and 2% of sub-genotype IB. In addition, sub-genotype IA and IB strains formed 25 different clusters. Genetically similar strains were also identified between 2001 and 2004 isolated from the southern and the central part of Tunisia, suggesting that an indigenous strain has been circulating in the Tunisia. The genetic profile of the VP1 region showed that Tun159-02 and Tun40-03 clustered respectively in the IB and IA sub-genotype, however, analysis of VP1/2A junction revealed in contrast that Tun159-02 and Tun40-03 clustered respectively in IA and IB. This is the first report to identify sub-genotype IA in Tunisia and provides new data on the genetic relatedness of HAV from Tunisia and the distribution of sub-genotype IA in this part of the world.
Amino Acid Sequence↗
Echinococcosis in Tunisia: a cost analysis.
Echinococcus granulosus infection is a preventable zoonosis of human and veterinary public health importance in Tunisia. We aimed to comprehensively quantify human and animal echinococcosis losses in Tunisia. Itemized cost menus were developed for the health of both domestic animals and humans, and for productivity monetary losses. The incidence and prevalence of the disease in all species were obtained from national and personal reports. The domestic animal and human costs of echinococcosis in Tunisia were estimated using age-stratified rates and losses, productivity losses (including those not formally employed) and Monte Carlo sampling to represent the uncertainty inherent in some epidemiological and economic values. Echinococcosis in Tunisia causes significant direct and indirect losses in both humans and animals of approximately US dollars 10-19 million annually. These estimates are based on numerous methodological improvements over previous studies and are of considerable consequence relative to Tunisia's US dollars 21.2 billion gross domestic product. A cost-benefit analysis of control programmes using the methodological advances presented here and regional comparison to other endemic diseases is warranted. These may provide information to assist policy decision-makers in prioritizing the allocation of scarce resources.
Animals↗
[Breast cancer in Tunisia: clinical and epidemiological study].
This study has been realized to determine epidemiological profile and clinicopathologic aspect of breast cancer in Tunisia. We have counted and analyzed all cancers of the breast diagnosed in Tunisia with proof pathologic or to defect cytologic of malignancy, between first January 1994 and 31 December 1994. In the course of this year, 689 new cases of mammary cancers have been diagnosed at the women. The average patient age was 50.0 years, the incidence standardized on the age of the cancer of the breast in Tunisia was 16.7/100,000 women. The average size of the tumor was 49.5 mm (35.8 mm at patients processed in private clinics and 50.7 mm at patients processed in the public hospitals). According to TNM classification of 1988, 7.2% of tumors were classified T1, 48.9% T2, 18.5% T3, and 23.4% T4 (6.2% T4d and 16.1% T4b). 22.1% of tumors were M1. 3.3% were in situ carcinoma. For the infiltrants cancers, the grade II SBR has been the most frequent (53.6%). On the therapeutic plan, the conservative processing has been practiced only at 17.6% of patients. The cancer of the breast in Tunisia rest again relatively little frequent, and its clinic profile resides alarming. The inflammatory cancer notion of the breast (equal T4d) intimately linked to Tunisia overestimates probably the reality. Cancers that were classified "PEV" in many publications would be in reality only for most of locally evolved and neglected cancers.
Adult↗
Vitamin D deficiency in Tunisia.
This study seeks to estimate the status of serum 25-hydroxyvitamin D [25(OH)D] in a healthy section of the population in Tunisia and to compare the achieved results with other published data. A transverse descriptive inquiry was carried out between January and March 2002. Three hundred and eighty-nine subjects aged 20-60 years were included in the study. A questionnaire was used to investigate clinical characteristics: sunlight exposure to ultraviolet light and, for women, parity, breast feeding, whether or not they wore the veil, and menopause. A dietary investigation estimated calcium and vitamin D intake. Morning fasting blood was collected from each subject for the measurement of the following parameters: serum calcium, phosphorus, albumin, alkaline phosphatase, 25(OH)D, parathyroid hormone (PTH). Hypovitaminosis D was defined by a cut-off of 37.5 nmol/l. The population studied was largely female, for the greater part housewives. The accumulated prevalence of hypovitaminosis D was 47.6%, increasing with age. Hypovitaminosis is highly prevalent in women (P<0.001). Multiparity, menopause, wearing the veil, and calcium and vitamin D dietary intake are factors associated with hypovitaminosis D (P<0.05). Analysis of logistic regression shows that only multiparity and vitamin D dietary intake are independent predictive factors. The status of serum 25(OH)D in Tunisia resembles that in southern European countries rather than in Middle Eastern countries. Insufficient vitamin D diet intake, higher parity and wearing the veil explain this deficiency in Tunisia. Dietary enrichment or supplementation by vitamin D and a more outdoor lifestyle, especially for older people, should be seriously considered as a way to reduce this deficiency in Tunisia.
Adult↗
[A comparative study of clinical and paramedical aspects of multiple sclerosis in Tunisia].
INTRODUCTION: Tunisia is considered as a low zone of prevalence for multiple sclerosis (MS). Consequently, only very few studies have taken an interest in this disorder in North Africa. The objective of this study was to compare the clinical and paraclinical parameters and the outcome of the disease in patients affected with MS in Tunisia during two periods (1974-1978 and 1996-2000) and to determine the incidence of the disease and the impact of the use of diagnostic criteria, including the MRI. PATIENTS AND METHODS: We report the results of a retrospective study concerning patients classified with MS and followed in the National Institute of Neurology in Tunis between 1974 and 2000, with 1058 records examined. We divided the patients into two groups belonging to two periods: Group I (1974-1978, 125 patients classified according to the McAlpine criteria) and Group II (1996-2000, 247 patients classified according to Poser's criteria. We compared the clinical and paraclinical parameters of the two groups. RESULTS: The incidence of the disease was evaluated at 1.3 per 100,000 individuals, placing Tunisia in the middle zone of prevalence. There was no significant difference in the mean age of onset (32.4+/-10.1 years) between the two groups. A slight male preponderance was observed in Group I (M/F sex ratio=1.25). The clinical outcome factors were age of onset after 40 years, pyramidal signs as the first symptom, and the progressive forms of the disease. Although Group II had an earlier diagnosis of the disease and a more systematic treatment of relapses, the functional outcome was similar between the two groups. CONCLUSION: MS in Tunisia has the same clinical characteristics and disease outcome as in other countries. The use of MRI allowed earlier diagnosis but did not increase the overall proportion of definite MS.
Adult↗
Contribution to the description of the beta-thalassemia spectrum in Tunisia and the origin of mutation diversity.
We determined the spectrum of beta-thalassemia (thal) mutations in 118 affected unrelated patients with different forms of beta-thal. Using a combination of reverse dot-blot analysis, denaturing gradient gel electrophoresis (DGGE), polymerase chain reaction/restriction fragment length polymorphism (PCR/RFLP) and direct nucleotide sequencing, we identified the largest spectrum of beta-thal mutations so far reported in Tunisia, and to the best of our knowledge, within the Mediterranean Basin. A total of 18 distinct alleles were detected at different frequencies, with two alleles [codon 39 (C-->T) and IVS-I-110 (G-->A)] predominating all others. Seven other alleles [frameshift at codon (FSC) 6 (-A), FSC 8 (-AA), codon 30 (G-->C), IVS-I-1 (G-->A), IVS-I-2 (T-->G), IVS-I-6 (T-->C), FSC 44 (-C)] were rare, and nine alleles [-29 (A-->G), IVS-I-2 (T-->C), IVS-I-5 (G-->C), IVS-I-5 (G-->T), IVS-I-116 (T-->G), codon 37 (G-->A), IVS-II-1 (G-->A), IVS-II-745 (G-->C) and IVS-II-849 (A-->C)], albeit described elsewhere, are reported here in Tunisia for the first time. The codon 39 and IVS-I-110 mutations were the two predominant alleles occurring at frequencies of 43.8% and 10.8%, respectively. They are presumably the earliest mutations introduced into this country. The codon 39 allele could have been introduced in Tunisia during the Roman occupation. Similarly, the IVS-I-110 mutation might have been introduced by the Turkish and Phoenician influence. Both gene flow and private mutations may account for the diversity of alleles observed in Tunisia. These data provide the background for implementing prevention programs based on genetic counseling and prenatal diagnosis.
Alleles↗
Analysis of the population structure of Mycobacterium tuberculosis in Ethiopia, Tunisia, and The Netherlands: usefulness of DNA typing for global tuberculosis epidemiology.
The genetic heterogeneity among Mycobacterium tuberculosis isolates from 501 patients in Ethiopia, Tunisia, and the Netherlands was compared by analysis of DNA polymorphism driven by insertion element IS6110. The percentage of isolates displaying two or more identical patterns differed greatly in the three countries: It was highest among Tunisian isolates and lowest in Dutch isolates. In contrast to isolates from Dutch subjects infected with M. tuberculosis, the majority of strains from Ethiopia and Tunisia were from a few families of genetically highly related strains. Furthermore, little overlap was observed among isolates from the three countries, indicating strict isolation of the bacterial reservoirs in the countries. A few strains from the Netherlands matched strains from Ethiopia and Tunisia. Those strains were invariably isolated from refugees, immigrants, or persons who visited Ethiopia or Tunisia.
Cluster Analysis↗
Comparative epidemiology of pemphigus in Tunisia and France: unusual incidence of pemphigus foliaceus in young Tunisian women.
Recent studies have suggested that in Tunisia, pemphigus foliaceus is more frequent in young women than expected. To confirm these findings, we compared the incidence rates of pemphigus in Tunisia as a whole and in a large area of France. New cases of pemphigus were detected retrospectively from dermatology departments and pathology laboratories over a 6-year period and classified as pemphigus vulgaris or foliaceus according to the pathology. In France, the incidence rate was 1.7 cases per million per year (95% confidence interval 1.4 to 2.1). Pemphigus vulgaris accounted for 73% of all cases, incidence increased with age, and the female-to-male sex ratio was 1.2. The incidence rate was significantly higher in Tunisia than in France: 6.7 cases per million per year (95% confidence interval 5.8 to 7.7); pemphigus foliaceus was more frequent (61%), the female-to-male sex ratio was 4.1, and the incidence rate was higher in young women. The incidence rate was 15.5 cases per million per year for pemphigus foliaceus among women aged 25 to 34 years and was even higher in some rural areas. No case was observed among household members or in neonates, and only one case occurred in childhood. Thus, we confirmed that the epidemiology of pemphigus in Tunisia is unusual. High rates of pemphigus foliaceus among young people living in rural areas are reminiscent of Brazilian pemphigus. However, the absence of cases among genetically related household members and during childhood, and the large predominance of women, contrast with Brazilian pemphigus.
Adult↗
Improving FP education in Tunisia.
JOICFP contributed expertise to a Japanese Evaluation Team of the Japan International Cooperation Agency (JICA), which was in Tunisia during September 16-30 to evaluate the implementation and achievements of the Project for the Promotion of Family Planning Education. The project, which is geared to promoting family planning (FP) education, was initiated in Tunisia in early 1993 by the National Office for Family and Population of Tunisia with technical cooperation from JICA. The team was headed by Dr. Takefumi Fukuhara, managing director, Medical Cooperation Department, JICA, and included five members from Japan. Ryoichi Suzuki, director, Information Division, JOICFP, contributed expertise on reproductive health as a resource person. During its stay, the team held discussions, exchanged views, and visited the field for firsthand observation. To promote FP education, the project has focused on such areas as improving the quality and quantity of video materials through the Audio Visual Center completed in Tunisia in 1995. The project has also emphasized the training of staff and implemented activities in two pilot areas. In summing up the achievements of the project, the team noted that the CPR in the remote pilot areas of Tataouine and Kasserine had increased from 33.7% and 35.8% in 1994 to reach 38% and 39.1% in 1996. Based on such achievements, the Japanese team and Tunisian side agreed to have further discussions for future collaboration in coordination with international agencies and donors such as UNFPA and the EU.
Advertising↗
Piroplasmids of livestock in Tunisia.
Several species of piroplasms of livestock are present in Tunisia; some of them are of high veterinary importance. This paper reviews the species already reported in Tunisia on the basis of clinical observations, parasitological routine diagnostic and serological surveys, as well as those considered as potentially present according to epidemiological argumentations. The genus Theileria includes four species reported in Tunisia: T. annulata, T. buffeli, T. ovis, and T. equi. The ovine malignant theileriosis agent, T. lestoquardi, appears to be absent in Tunisia. Five species belonging to the genus Babesia were reported in the country, namely B. hovis, B. bigemina, B. divergens, B. caballi, and B. ovis. Furthermore, two more species, B. major and B. motasi, are potentially present in zones where their vectors of the genus Haemaphysalis occur.
Animals↗
[Clinico-epidemiologic forms of cutaneous leishmaniasis in Tunisia].
From an analysis of 1,546 cases of cutaneous leishmaniasis collected throughout Tunisia three clinico-epidemiological forms could be determined. These forms are due to three different species of Leishmania and are observed in different geographical areas. Sporadic cutaneous leishmaniasis (SCL), 63 cases. This form is found in Northern Tunisia, in known foci of Kala-azar. 96% of the patients have a single, small, ulcerated and crusty lesion on the face surrounded by an important zone of infiltration. Amastigotes are less than 4 microns in diameter, and it is very difficult to maintain the parasites in cultures. This form is probably due to Leishmania infantum, as has been demonstrated in Algeria in a similar form evolving in the same biotope as the Tunisian form. The vector and reservoirs of SCL are unknown. Zoonotic cutaneous leishmaniasis (ZCL), 1,412 cases. The disease is epidemic in Central and Southern Tunisia. The lesions are multiple; they affect the limbs more frequently than the face and heal in less than 8 months. They are polymorphous, usually large and superinfected. There is a seasonal occurrence of the outbreaks (summer and autumn). Amastigotes are large (4 to 6.5 microns in diameter) and the parasites easily grow in cultures. This form is caused by Leishmania major, and its vector is Phlebotomus papatasi. Three species of rodents harbour the parasite. Anthroponotic cutaneous leishmaniasis (ACL), 71 cases. This form is endemic in South-Eastern Tunisia. 70% of the patients present with single lesions, one half of which affect the face. Dry and proliferating lesions are the most frequent.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
[Comparative epidemiology of pemphigus in Tunisia and France. Incidence of foliaceus pemphigus in young Tunisian women].
INTRODUCTION: Recent studies have suggested that pemphigus foliaceus is quite frequent in young Tunisian women. In order to confirm this hypothesis, we compared the incidence of pemphigus in general in Tunisia with that in the Ile-de-France region. METHOD: All new cases of pemphigus diagnosed during a 6-year period were reviewed in our dermatology and pathology laboratories. These cases were classed as pemphigus foliaceus or pemphigus vulgaris on the basis of histology reports. RESULTS: In France, the incidence was 1-7 new cases per million per year (95 p. 100 confidence interval 1.4-2.1). Pemphigus vulgaris was diagnosed in 73 p. 100 of the cases with an incidence increasing with age. Sex ratio (F/M) was 1.2. The incidence observed in Tunisia was significantly higher than that observed in France with 6.7 new cases per million per year (95 p. 100 confidence interval 5.8-7.7). Pemphigus foliaceus was more frequent (61 p. 100), the sex ratio (F/M) was 4.1. Incidence was higher in young women, with 20 new cases of pemphigus foliaceus per million per year among women from 25 to 34 years of age. These levels were higher in rural desert areas. No familial cases were observed and only one case occurred in a child. DISCUSSION: These findings confirm the specific epidemiology of pemphigus in Tunisia, which appears to be similar and also different from that in Brazilian pemphigus. As in Brazil, there was a predominance of pemphigus foliaceus in young adults living in rural areas in poor socioeconomic conditions. However in Tunisia the disease predominates significantly in women and there are no familial and rare juvenile cases.
Adult↗