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Biomedical subjects

B Zouari

Publications and source records attributed to B Zouari.

At least 19 recordsLinked to original sources
PubMed2006

The global diabetes pandemic: the Tunisian experience.

OBJECTIVE: The prevalence of diabetes mellitus is known to be increasing rapidly worldwide, but few population-based surveys have been undertaken in Africa or the Middle East. The aims of this study are to report the prevalence of diabetes mellitus and impaired fasting glucose (IFG) in Tunisia, to compare the prevalence to previous studies and to analyse the relationship between diabetes and age, sex, area of residency and body mass index (BMI). SUBJECTS AND SETTING: We have used data from the Tunisian National Nutrition Survey, a cross-sectional health study providing a large nationally representative sample of the Tunisian population including 3729 adults. We used the American Diabetes Association diagnostic criteria to determine the prevalence of diabetes mellitus and IFG. RESULTS: The overall diabetes prevalence was 9.9% (9.5% in men and 10.1 in women) giving age-adjusted prevalence of diabetes of 8.5% (7.3% in men and 9.6% in women). Step-wise logistic regression showed age of more than 40 years, urban residency and high BMI to each be significantly and independently related to diabetes prevalence. The prevalence of diabetes mellitus has more than doubled in Tunisia over a 15-year period. CONCLUSIONS: Our study has demonstrated a high prevalence of diabetes in the adult population with a wide difference among the rural and urban areas with an increased prevalence compared to previous studies. The results underline the need to increase public awareness and to emphasize the benefit of lifestyle modification in order to prevent type II diabetes.

Adult↗
PubMed2006

[Prevalence of osteoporotic fractures in Tunisian women].

PURPOSE OF THE STUDY: Osteoporotic fractures are an important public health problem due to significant morbidity and mortality and the socioeconomic burden. In Tunisia, the impact of such fractures is often underestimated due to lack of epidemiological data. We evaluated the prevalence of these fractures in a sample population at risk in order to better ascertain the amplitude of this problem in our country. MATERIAL AND METHODS: This prospective study involved 2,000 menopaused women aged 50 years or more. The sample was randomly selected among the population of Manouba, an urban administrative district of the capital of Tunisia. One thousand three hundred eleven women agreed to participate in this survey. Women with a risk of secondary osteoporosis were excluded. We retained for study fractures related to primary osteoporosis. History taking recorded anthropometric data and medical history, particularly gyn-ob history. All fractures occurring after minor trauma, in women aged 50 years or more, and involving the femoral neck, the wrist, or the proximal humerus were noted. Lateral x-rays of the thoracolumbar spine were studied to search for unrecognized vertebral fractures. RESULTS: The study population included 1,311 women, mean age 64.07 +/- 9.31 years, menopaused at mean 48.29 +/- 3.84 years. Among these women, 212 (16.2%) had presented a fracture at one of the localizations retained for study. Vertebral wedge fractures accounted for 59.83% of all fractures, wrist fractures 31.96%, proximal femoral fractures 4.51% and proximal humeral fractures 3.69%. DISCUSSION: Osteoporotic fractures are not uncommon in women in Tunisia. Increasing life expectancy in our country suggests this public health problem will grow in the years to come, pointing out the importance of better management of osteoporosis to prevent fractures.

Female↗
PubMed2006

[Skin diseases in the elderly: a multicentre Tunisian study].

INTRODUCTION: With progressive aging of populations, geriatric health care has become a major international issue for health authorities. However, little data is available about geriatric skin diseases. The aim of this study is to determine the pattern of skin disorders among elderly patients seen in private and public skin outpatient clinics in Tunis. PATIENTS AND METHODS: We performed a prospective, multicentre and descriptive study of all new skin diseases diagnosed in dermatological outpatients aged over 65 years. This study lasted one year (June 1999 to July 2000) and evaluated the activity of eleven Tunisian dermatologists in private or public practice, who collated all cases of skin diseases diagnosed in their practices. RESULTS: A total of 1518 patients with 1550 new diagnoses were examined. Mean age was 72.6 years with a sex M/F -ratio of 1.41. Fungal infections were the most common conditions (16.9%), followed by tumors 12.8% (benign 63.3%), eczema (11.9%), keratinization anomalies (8.7%), bacterial infections (8.7%), viral infections (6.8%) and pruritus (6.4%). Fungal infections were mainly represented by toe-web intertrigo and onychomycosis. Basal cell carcinoma and epidermoid cysts were the most common malignant and benign tumors respectively. DISCUSSION: This study reflects the frequency of mycoses, benign tumors and eczema in elderly patients. This is consistent with the results of other studies of the literature showing eczema as the predominant skin disease. The high prevalence of mycosis in our study may be explained by climatic conditions (heat, moisture). Pruritus seems to be frequent in geriatric patients. Skin disorders are an important source of morbidity in elderly patients.

Aged↗
PubMed2006

Prevalence of metabolic abnormalities in the Tunisian adults: a population based study.

AIMS: To estimate the prevalence of individual metabolic abnormalities and the cluster of metabolic abnormalities in a representative sample of the Tunisian adult population and to identify their relationship with gender, age and residency. The definition used is an adaptation of the NCEP ATP III definition, using total cholesterol>or=5.2 mmol/l instead of HDL-cholesterol. MATERIALS AND METHODS: We used a sample of the Tunisian National Nutrition Survey (TNNS), a cross-sectional health survey conducted in 1996, to estimate the nutritional status of the population. The TNNS included 2 927 adults aged 20 years or older who had measurements of height, body weight, waist circumference, blood pressure, fasting plasma glucose, total cholesterol and triglycerides. The cluster of metabolic abnormalities was defined as the presence of three or more metabolic abnormalities. RESULTS: The prevalence of abdominal obesity, hypertriglyceridemia, high total cholesterol, high blood pressure and high fasting plasma glucose was, respectively, 9%, 23%, 24%, 45% and 15% in men and 33%, 19%, 29%, 44% and 15% in women. The prevalence of the cluster was more frequent in women than in men (18% versus 13%, P<0.001) and in those living in urban communities (21% in women, 16% in men) rather than rural communities (11% in women, 8% in men) (P<0.001). The prevalence also increased significantly with age (P<0.001). CONCLUSION: The cluster of metabolic abnormalities and its components are common in the Tunisian adult population and prevalence increases significantly with female sex, urban residency and age.

Blood Glucose↗
PubMed2005

[Colonic expression of gamma-interferon and interleukin-10 in Crohn's disease and ulcerative colitis].

OBJECTIVE: The aim of this study was to investigate mucosal expression of INF-gamma and IL-10 in patients with Crohn's disease (CD) or ulcerative colitis (UC). METHODS: Fourteen patients with CD and 11 patients with ulcerative colitis participated and 7 healthy subjects were also included. Study of the mucosal expression of INF-gamma and IL-10 was conducted using biopsies from healthy and damaged colons, using the inverse transcription and genetic amplification (RT-PCR) technique in real time (Taqman). Our results were expressed as ratio between messenger cytokine (mRNA) levels and ribosomal RNA level of a reference molecule (rRNA 18S), then multiplied by 108. RESULTS: In the cases of Crohn's disease, the mucosa expressed increased INF-gamma and IL-10 compared with controls (respective medians: 23.03 vs. 1.87 p=0.04 and 20.61 vs. 2.13 p=0.08). A strong positive correlation was found in the mucosal expression of IL-10 and INF-gamma during CD (r=0.9 p<0.0001). In contrast, in patients with UC, the expression of INF-gamma and IL-10 were comparable to those observed in the controls (7.18 vs. 2.18 p=0.36 and 3.66 vs. 1.87 p=0.44). CONCLUSION: During Crohn's disease, the expression of both IL-10 and INF-gamma was increased and strongly correlated, compared with the controls.

Adolescent↗
PubMed2005

[Risk factors for diabetic macular edema].

AIM: To determine the risk factors involved in the development of macular edema. PATIENTS AND METHODS: A retrospective, case-control study conducted on 200 diabetic patients with diabetic retinopathy: 100 patients with macular edema and 100 control patients. All patients were examined using slit-lamp biomicroscopy completed by fluorescein angiography. A physical examination and the appropriate biological investigations were also carried out. Statistical significance was determined by the chi square test and Fisher's exact test. A value of p<0.05 was considered statistically significant. RESULTS: The incidence of macular edema was significantly associated with longer duration of diabetes, a higher level of glycemia, the type of diabetes in the older onset group using insulin, the severity of diabetic retinopathy at baseline, and old age. Panretinal photocoagulation was also found as a risk factor for macular edema. CONCLUSION: These data suggest that laser photocoagulation, reduction of hyperglycemia and better control of other factors may result in a beneficial decrease in macular edema.

Case-Control Studies↗
PubMed2005

Celiac disease in adult patients with type 1 diabetes mellitus in Tunisia.

OBJECTIVE: Type1 diabetes mellitus may be associated with celiac disease. The prevalence of celiac disease as determined by screening among adult patients with type 1 diabetes is high with rates of 1.07.8% in Europe and U.S.A. The aims of the study are to determine the prevalence of celiac disease in adults with type 1 diabetes in Tunisia. METHODS: 348 consecutive adult patients with type1 diabetes were investigated prospectively and screened for celiac disease. The mean age was 28.45+/-10.74 years old. There were 176 females and 172 males. For the screening of celiac disease, we used immunoglobulin A (IgA) anti-endomysium (EMA) antibodies determined by an indirect immunofluorescence method. Anti-transglutaminase (tTG) antibodies were determined by an ELISA method. Those patients with positive results for anti EMA and or tTG were proposed for duodenal biopsy. RESULTS: 14 patients were positive for anti EMA and had high or a weak positive level of tTG antibodies. One patient from this group was already known to have celiac disease. Only 8 patients consented to biopsy and morphological changes were consistent with celiac disease in all cases. Prevalence of biopsy-proven celiac disease was 2.3% (95% CI=1.0-4.5%). CONCLUSION: The present study confirms that celiac disease of adults is prevalent in type 1 diabetic patients in Tunisia. Serological screening for celiac disease in type 1 diabetes is important because many patients are asymptomatic and most are detected by the screening.

Adult↗
PubMed2004

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↗
PubMed2002

[Full optical correction after cycloplegia in headache].

PURPOSE: To study the advantages of cycloplegia in the accurate assessment of refractive errors and to evaluate the impact of full optical correction in the course of headache. MATERIAL: and methods: A prospective study was carried out in 164 eyes of 82 patients with headache. Corrected visual acuity was 10/10 in all cases. Refraction was measured before and under cycloplegia by cyclopentolate with a CANON R 50 infrared autorefractometer. Full optical cycloplegic correction based on the value of refraction under cycloplegia was prescribed in all cases. Mean follow-up was 10 months. Statistical analyses were used: Student's t test, Pearson coefficient correlation, and Chi2. RESULTS: Under cycloplegia, hypermetropia was significantly the most frequent ametropia (67.1%, p<10(- 9)). The difference between the spherical equivalent, before and during cycloplegia, was highly significant (p<10(- 5)) at 0.79. Optical correction eliminated headaches in 76.5% of the cases. CONCLUSION: The authors conclude on the role of accommodation in headache onset and the need to continue cycloplegia until the age of 45. The importance of optical correction in alleviating headaches is underlined.

Accommodation, Ocular↗
PubMed2002

[Prevalence and risk factors of non-insulin-dependent diabetes mellitus in the rural and urban population of Tunisia].

BACKGROUND: Prevalence of non-insulin-dependent diabetes mellitus was analyzed from a baseline survey of risk factors for cardiovascular disease in a random sample of the 35-50-year old population of the Gouvernorat of Nabeul, Tunisia. METHODS: Diabetes was assessed on the basis of an interview and fasting blood glucose level among a sample of 692 men and women (35% aged 35-40 years, 30% aged 40-45 years, 35% aged 45-50 years). RESI;TS: Forty-six percent of the sample were men. The prevalence of diabetes was 7.2%; two-thirds of the identified cases of diabetes were known. The prevalence of diabetes was much higher in the urban area (9.3% in men and 10.4% in women) compared with the rural area (2.0% in men and 4.5% in women). Mean body mass index was significantly different (p<0.01) between normal and diabetic subjects. Hypertension was three times higher in diabetic subjects (33%) than in normal subjects (9%). Triglycerides level was higher in diabetic subjects (1.92+/-1.72mmol/l) compared with non-diabetic subjects (1.29+/-1.02mmol/l). There was a positive relation between blood glucose level and triglycerides level, independently of obesity in women, but dependently in men. CONCLUSION: In the Tunisian population, known to have a low level of cardiovascular risk factors, the relationships between diabetes, obesity, hypertension, and lipid abnormalities are similar to those observed in Western populations.

Adult↗
PubMed2002

[Current aspects of Pott's disease in Tunisia. 29 cases].

It is a retrospective study, reviewing all cases of vertebral tuberculosis recorded between 1989 and 1999 in La Rabta Hospital (Tunis). 29 patients have been included whose average age was 49 years. The main symptoms which appeared within a average period of six months were vertebral pain, associated with fever in half of the cases. The diagnosis of infectious spondylitis was made according to the results of Computer tomography in 26 cases. The diagnosis of infection was confirmed by characteristic histological pattern and/or culture biopsy. 27 patients were cured without complications except for 2 of them who developed a spinal cord compression. This complication was quickly stemmed by steroid therapy.

Age Distribution↗
PubMed2001

Predictive risk factors for deterioration from normoglycemic state to type 2 diabetes mellitus or impaired glucose tolerance in a Tunisian urban population.

OBJECTIVE: To determine the predictive risk factors for the development of type 2 diabetes mellitus (DM) or impaired glucose tolerance (IGT) in a normoglycemic population. RESEARCH DESIGN AND METHODS: This is a ten-year prospective study in a randomly selected urban population including 1835 subjects aged >=30 years living in Tunis, 1460 were normoglycemic according to 2 hours blood glucose WHO criteria, and 701 among them attended the follow-up assessment ten years later. Subjects with impaired glucose tolerance (IGT) were excluded. Subjects underwent a physical examination including weight/height, iliac circumference (IC) and blood pressure measurements. Fasting and 2-hour venous blood sampling, after a 75 g oral glucose load, were performed for the measurement of plasma glucose (G(0), G(2h)), insulin (I(0), I(2h)), total cholesterol (TC) and glycated hemoglobin (HbA(1c)) levels. RESULTS: Out of the 701 normoglycemic subjects in 1985, 77 developed diabetes and 130 impaired glucose tolerance after 10 years, giving a mean annual incidence rate of 1.1% for diabetes and 1.85% for IGT. Univariate analysis showed that risk factors for diabetes were age, BMI, IC, SBP, G(0) and total cholesterol in both sexes, I(0) and I(2h) in men only and DBP G(2h) and HbA(1c) in women only. Risk factors for IGT were BMI, IC and G(2h) in both sexes, I(2h) in men only and G(0) in women only. Multivariate analysis revealed that BMI, G(0) and G(2h) were independent risk factors for conversion to diabetes or IGT in both sexes, but HbA(1c) and IC were risk factors only in men. CONCLUSION: Early screening and prevention of diabetes must focus on obese subjects, especially those with central fat distribution, and those with moderate increase in fasting and/or two-hour blood glucose levels within the normal range.

Adult↗
PubMed2001

Insulin therapy may increase blood pressure levels in type 2 diabetes mellitus.

OBJECTIVE: To assess the effects of insulin therapy on blood pressure levels in type 2 diabetes mellitus (T2 DM). MATERIAL AND METHODS: This is a retrospective analysis of clinical records of 313 T2DM patients (125 men and 188 women), excluding those with proteinuria or hypertensive diseases and those taking drugs that may influence blood pressure levels except antihypertensive therapy. Mean age was 56.3 +/- 11.7 years and mean duration of diabetes was 7.1 +/- 5.5 years. After one week of observation under diet and maximal doses of oral antidiabetic drugs, patients who did not improve their glucose control were changed towards insulin therapy (n=129) and formed the insulin treated group (ITG), those who improved their glucose levels were maintained under oral therapy (n=184) and formed the orally treated group (OTG). Blood pressure levels were compared between the two groups at baseline and after a mean follow-up period of 12.1 +/- 6.1 months. Hypertension was considered if patients were known and treated or if SBP >=140 mmHg and/or DBP >=90 mmHg. RESULTS: At baseline, patients in ITG were moderately older (58.4 +/- 11 vs 54.9 +/- 12.1 years, p<0.05), had a longer duration of diabetes (9.2 +/- 6.2 vs 5.7 +/- 5 years, p<0.01), a lower BMI (24.6 +/- 4.6 vs 28.8 +/- 6.6 kg/m(2), p<0.01) and a higher frequency of retinopathy (44% vs 31.1%, p<0.05). There was no significant difference regarding sex ratio, WHR, family history of hypertension, plasma levels of creatinine and lipid parameters. SBP, DBP and frequency of hypertension were similar in both groups at baseline. After follow up, insulin treated group exhibited higher levels of SBP (150 +/- 25.7 vs 138.6 +/- 27.1 mmHg, p<0.001) and DBP (84.1 +/- 13 vs 75.8 +/- 14.9 mmHg, p<0.001) than orally treated group. Progression rate of hypertension frequency was mildly but not significantly higher in ITG than in OTG (+21% vs +12%, p=0.08) and was associated with weight gain in ITG only. SBP increase was mildly correlated with weight gain (p=0.06). In ITG, higher values of BMI (> 27 kg/m(2)) at baseline were associated with the highest increases of blood pressure levels under insulin therapy. No significant relationship was found with insulin doses. CONCLUSION: Insulin therapy may contribute to the development of hypertension in T2DM obese patients. Additional prospective randomised studies are required for a better appreciation of such influence.

Adult↗
PubMed2001

[Vaccination against viral hepatitis B for public health personnel: the case of the National Fund of Social Security].

Viral hepatitis B is endemic in Tunisia at an intermediate level. Health professional are a group particularly exposed to the infection. Immunization is the most efficient way to prevent this disease. In this study, we had try to estimate the cost of three strategies of immunization: immunization after a complete serology, immunization after a sequencial serology and immunization without previous serology. The study was conducted at the clinic of the National Fund of Social Security in El Khadra. All the personal of the clinic was invited to participate to a program of immunization after complete serology. Participation rate was at 93.8%. 33.3% of the personal was immunized (24% by a previous contact with the virus and 9.9% by a previous immunization). The costs of the three strategies were as below: immunization after complete serology: 53.4 tunisian dinars by person. immunization after sequantial serology: 33.06 tunisian dinars by person. immunization without serology: 16.2 tunisian dinars by person. Immunization without previous serology has the lower cost, and doesn't expose at any sid effect. However, a post immunization serology vaccinal should be desirable.

Adult↗
PubMed2001

[Ramadan and customs of life: investigation with 84 adult residents in the district of Tunis].

To know nature and the dimension of the change of the customs of life leads by the Ramadan, we led a comparative descriptive inquiry before and during the month of the fast at 84 adults residents in the district of Tunis. Our results underline an increase of the consumption of meat and eggs with an average frequency of 4.3 and 6.1 times a week respectively. This overconsumption of the animal proteins contrasts with a tendency in the decline of the consumptions of vegetables. The exciting (tea, coffee, tobacco) are less consumed during the Ramadan. Also, we noted a decline of 50% of the average number of smoked cigarettes. There is an intensification of domestic links with an increase of the frequency of exchange of domestic visits. It's crossed of average from 0.7 to 1.2 times a week (p < 0.001). The phenomenon of irritability is frequently lived by near 20% of the investigated. We recommend under shape of an educational program the intensification of positive customs and the correction of negative customs, to benefit of sacred month, to tighten towards a more balanced life all year.

Activities of Daily Living↗
PubMed2001

[Surveillance system of maternal mortality in the Tunis region].

In the framework of a national strategy of reduction of the maternal mortality rate. Tunisia has set up a follow up system of maternal deaths occurring in public facilities to analyse their causes, the levels of deficiency and to propose solutions for preventing them. This note aims at describing the system, its results, its efficiency and its limitations in the Tunis region for the years 1999 and 2000. The results show a maternal mortality rate estimated at 80 for 100,000 births in public facilities of the region: the main causes being haemorrhage (42.1%) followed by infection (13.2%). The proportion of avoidable deaths is 87%:74% possibly avoidable and 13% certainly avoidable, factors related to women behaviour have also contributed to 45% of cases. The system flows are however intricated, and related to organization: an underestimation of risk by the patient (33%), an inadequate watch during the postpartum period (25%), a late hospitalisation (22%) and not enough reanimation equipment. Nevertheless, this control system has achieved part of its objective by starting up a quality approach to obstetrical cares and by warning health professionals such as obstetricians, anaesthetists, blood banks in charge, hospital managers and other medical teams. The limitations of the system are tied to the follow up of the real implementation of recommendations stated in reports at a local as well as central levels.

Bias↗