[Migration, risks and opportunities]. / Migration : risques et opportunités.

The migration is considered for a long time as a risk for mental health, to which are exposed both migrants and their descendants. Indeed, the risk of developing schizophrenia, particularly, is multiplied by 2 to 3. Today, it is offending in the 'jihadist' terrorism that bruises in countries of immigration, including France. In fact, the majority of the perpetrators of deadly attacks come from the immigrant minority. We will show that the main common factor to both phenomenons is not migration but the social exclusion which is, unfortunately often linked to it. We will also show that this exclusion is as much the fact of the host society which advocates the cultural assimilation of immigrants as that of the migrant community, trapped by its cultural defector status and its conflict of loyalty. We conclude that migration is above all an opportunity for mutual enrichment if you advocate the integration, therefore, interculturality, that is an exchange reciprocal customs and values.

Occupational blood exposure among health care personnel and hospital trainees.

Blood and body fluid Exposure is a major occupational safety problems for health care workers. Therefor We conducted a descriptive and retrospective study to identify the characteristics of blood exposure accidents in health care settings which lasted five years (2005-2009) at the two university hospitals of Sfax. We have 593 blood exposure accidents in health care settings 152 (25.6%) health personnel and 441 (74.4%) trainees' doctors, nurses and health technicians. The mechanism of blood and body fluid exposure was accidental needle-stick injury in 78.9% of health staff, and 81% of trainees, accidental cut in 14.7% of health workers and 10.2% of trainees. The increasing severity of blood exposure accidents is linked to the lack of safe behavior against this risk.

[Rubella seroprevalence in Tunisian childbearing women two years after vaccination program introduction]. / Séroprévalence de la rubéole chez la femme en âge de procréer deux ans après l'introduction de la vaccination en Tunisie.

UNLABELLED: Acquiring rubella during the first 20 weeks of pregnancy can lead to teratogenic effects. AIM: The aim of the study was to investigate the impact of rubella vaccination strategy two years after its introduction in Tunisia in 2005. METHODS: This study was conducted over two periods, 2000 and 2007-2008. A total of 15,776 childbearing women were enrolled in the sample. Serological studies were performed by using the ELISA method. RESULTS: Overall, rubella infection seroprevalence did not increase between 2000 and 2007-2008. Nevertheless, a significant increase in seroprevalence, from 78.2% in 2000 to 92% in 2007-2008 (P=0.006), was especially noted in the age group under 20 years. Seroprevalence did also statistically increase with parity in 2007-2008 from 77.4% in women without any parity to 89.8% in women with over three parities (P=0.01). CONCLUSIONS: Results improvements seem most likely due to mass vaccination campaign for girls aged from 13 to 18 years in 2005, and also routinely post-partum vaccination of seronegative pregnant women or women ignoring their rubella status. In the coming years, systematic selective immunization of 12-year-old schoolgirls who are not yet entering their prime childbearing years will achieve female population sufficient immunity.

[Congenital rubella still exists in Tunisia!]. / La rubéole congénitale existe encore en Tunisie !

Congenital rubella syndrome resulting from maternal rubella infection can cause serious multisystemic malformations resulting in severe morbidity and mortality. After immunization, its incidence has been reduced in the developed world, though it remains a real problem in developing countries since it causes many handicaps. In Tunisia, despite including rubella immunization in the routine national program on immunization for girls once they reach the age of 12, the congenital rubella syndrome still exists. We describe the clinical pattern and the outcome of congenital rubella syndrome in 2 infants and emphasize the necessity of recommending universal screening and follow-up vaccination of susceptible females and including rubella immunization in the routine national immunization program, especially in developing countries.

[Juvenile nasopharyngeal carcinoma: anatomoclinic, biologic, therapeutic and evolutive aspects]. / Les cancers du cavum juvéniles: aspects anatomocliniques, biologiques, thérapeutiques et évolutifs.

Nasopharyngeal carcinoma (NPC) represents one of the most frequent epithelial tumours of the child in intermediate risk regions. In the Maghreb, it represents the first cancer of teenagers of 15-20 years old. The Epstein Barr virus (EBV) is the most important etiologic factor. Its role in the pathogeneses of NPC has been confirmed by several studies. Young NPCs are characterized by a low rate of EBV antibodies and a high level of LMP1 cell expression than in adult's NPC. The undifferentiated carcinoma nasopharyngeal type (UCNT) represents the most frequent histological type. Immunohistochemical analyses of North Africa early onset NPC is characterized by a weak expression of bcl-2 and p53 and a strong expression of LMP1 and c-kit what makes them different from the adult's NPC. Clinically, cervical node involvement is constantly present. Juvenile NPC is characterized by a very important locoregional extension as well as a high rate of distant metastases. More than 15% of patients had metastases at diagnosis. Radiotherapy is still the standard therapy of NPC. Only some retrospectives studies have been published to determine the benefit, the type and the timing of the chemotherapy in the treatment of juvenile NPC. Metastatic relapses constitute the main cause of death at these young patients. An improvement of the prognosis can be waited with concomitant chemotherapy and intensity modulated radiotherapy. However, randomized multi institutional studies are necessary to standardize the treatment of the NPC in childhood.

[Pediatric nasopharyngeal carcinoma: Anatomoclinic aspects, therapeutic results and evolutive particularities]. / Le cancer du cavum de l'enfant et l'adulte jeune : aspects anatomocliniques, thérapeutiques et particularités évolutives.

PURPOSE: We retrospectively analyzed anatomoclinic, therapeutic and evolutive particularities of 74 young patients (< or =20 years) with nasopharyngeal carcinoma treated between 1993 and 2005. PATIENTS AND METHODS: Initial work-up included a fiberoptic nasofibroscopy with biopsy, tomodensitometry and/or MRI of nasopharynx and neck, chest X-ray, abdominal ultrasonography and bone scan. Patients were treated with either primary chemotherapy (epirubicin and cisplatin) followed by radiotherapy or concomitant radiochemotherapy (five fluorouracil and cisplatin). Radiotherapy was delivered to a total dose of 70 to 75 Gy to nasopharynx and involved cervical lymph nodes and 50 Gy to the remainder cervical areas. RESULTS: The median age was 16 years. Sixty-three percent of patients had undifferentiated tumors. Sixty-six percent had locally advanced tumor. With a median follow-up of 107 months, one patient presented a local relapse, 24 patients developed distant metastases with a median delay of 7 months. The 5 years overall survival and disease-free survival were 66 and 65 %. Late complications were dominated by dry mouth and endocrine disorders. COMMENTS: Pediatric nasopharyngeal carcinoma is characterized by an early metastatic diffusion. Local control is excellent but with severe late toxicities. New techniques of radiotherapy and new molecules of chemotherapy could improve these results.

[Metastatic nasopharyngeal carcinoma: clinical study and therapeutic results of 95 cases]. / Les cancers métastatiques du nasopharynx: étude clinique et résultats thérapeutiques de 95 cas.

PURPOSE: The objective of this retrospective study was to discuss the epidemioclinical criteria and the therapeutic results of metastatic nasopharyngeal carcinoma. PATIENTS AND METHODS: The current study concerned 95 patients with histologically proven nasopharyngeal carcinoma who were metastatic at diagnosis or who had developed late metastasis. We reviewed the epidemioclinical records of all the patients. Patients were treated with chemotherapy (BEC regimen: bleomycin, epirubicin and cisplatin or PBF regimen: bleomycin, 5-fluorouacil and cisplatin) and radiotherapy of pauci metastatic localizations (single or double) or bone metastasis with high risk of compression or fracture+/-associated with locoregional radiotherapy for patients who were metastatic at diagnosis. Response was assessed according to the WHO criteria. Overall survival was calculated according to the Kaplan-Meier method. A long-term disease-free survival was defined from 36 months. RESULTS: There were 34 patients who were metastatic at diagnosis and 61 patients who had developed late metastasis. The mean age was 41.5 years (sex-ratio: 3.1). Bone metastases were the most frequent (83%). Objective and complete response rates were respectively 75% and 70%, and 32% and 16% for BEC and PBF regimens. Twenty-five patients received radiotherapy for pauci metastatic localizations, among whom 19 patients who were metastatic at diagnosis received locoregional irradiation. The overall survival probability was of 15% for three years. Eleven patients were long survivors (extremes: 36 and 134 months). CONCLUSION: Therapeutic results were comparable to those reported in other series using platin combination chemotherapy. Radiotherapy of metastasis yielded to long-term survival.

Comparison of three different serological techniques for primary diagnosis and monitoring of nasopharyngeal carcinoma in two age groups from Tunisia.

Nasopharyngeal carcinoma (NPC) in Tunisia is characterized by its bimodal age distribution involving juvenile patients of 10-24 years and adult patients of 40-60 years. Three serological techniques were compared for primary diagnosis (N = 117) and post-treatment monitoring (N = 21) of NPC patients separated in two age groups. Immunofluorescence assay (IFA) was used as the "gold standard" for detection of IgG and IgA antibodies reactive with Epstein-Barr virus (EBV) early (EA) and viral capsid (VCA) antigens. Results were compared with ELISA measuring IgG and IgA antibody reactivity to defined EBNA1, EA, and VCA antigens. Immunoblot was used to reveal the molecular diversity underlying the anti-EBV IgG and IgA antibody responses. The results indicate that young NPC patients have significantly more restricted anti-EBV IgG and IgA antibody responses with aberrant IgG VCA/EA levels in 78% compared to 91.7% in elder patients. IgA VCA/EA was detected in 50% of young patients versus 89.4% for the elder group (P < 0.001). Immunoblot revealed a reduced overall diversity of EBV antigen recognition for both IgG and IgA in young patients. A good concordance was observed between ELISA and IFA for primary NPC diagnosis with 81-91% overall agreement. Even better agreement (95-100%) was found for antibody changes during follow-up monitoring, showing declining reactivity in patients in remission and increasing reactivity in patients with persistent disease or relapse. ELISA for IgA anti-VCA-p18 and immunoblot proved most sensitive for predicting tumor relapse. VCA-p18 IgA ELISA seems suitable for routine diagnosis and early detection of NPC complication.

In nasopharyngeal carcinoma-bearing patients, tumors and lymphocytes are infected by different Epstein-Barr virus strains.

Despite the fact that most adult humans worldwide are latently infected by the Epstein-Barr virus (EBV), only a very small percentage of them will develop an EBV-associated malignancy. We do not know whether this situation reflects the existence of more sensitive individuals or of particularly tumorigenic EBV strains. We postulated that if highly tumorigenic EBV strains did exist, they would be preferentially found in consistently EBV-associated tumors, such as nasopharyngeal carcinoma (NPC), and differ significantly from the strains present in other, non-pathological sites of the same patients. To test this hypothesis, we compared the BNLF1 gene of the EBV strains present in tumors and in "reservoir lymphocytes" of 6 NPC-bearing patients from Tunisia. Our results show that all of these patients were infected by more than 1 (and up to 7) EBV strains. Moreover, lymphocytes and tumor cells from the same individual were systematically infected by different viral strains. The origin and biological significance of these multistrain infections are discussed.

[The isolated presence of anti-HBc antibodies: prevalence and interpretation based on the results of viral DNA research and anti-HBs antibodies measurement after vaccination]. / Présence isolée de l'anticorps anti-HBc: prévalence et interprétation à l'aide des résultats de recherche d l'ADN viral et du dosage des anticorps anti-HBs après vaccination.

In order to study the significance of the isolated presence of anti-HBc antibodies, we have looked for the 3 classic serological markers of the hepatitis B (HBs antigen, anti-HBs and anti-HBc antibodies) in 1,586 hospital agents who are to vaccinate in the framework of a campaign of systematic vaccination of the hospital personnel of university hospitals of Sfax for a period of 18 months. We identified subjects who presented isolated anti-HBc antibodies (33 individuals = 2.08%). In these subjects'serum, we performed a research of the DNA of hepatitis B virus (HBV) with a PCR hybridization technique using a couple of primers. One week after administration of a vaccine dose, we also measured anti-HBs antibodies in their sera. Among the tested 18 personnel with anti-HBc isolated antibodies, 11.1% had low rates of anti-HBs antibodies indicating that there is presumably primary antibody response and therefore a false positivity of anti-HBc antibodies in pre-vaccinal serology; while 11.1% others had higher rates of anti-HBs antibodies corresponding to a secondary antibody response, which witness a previous HBV immunisation. The research of the HBV-DNA was positive in 11.1% of tested personnel, testifying a presumably chronic portage of the virus with low rates of the HBs antigen undetectable with the serological techniques. For the remainder subjects with isolated anti-HBc antibodies (66.7%), the interpretation remains ambiguous.

[Prevalence of anti-CMV antibodies in blood donors in the Sfax region (value in blood transfusion)]. / Prévalence des anticorps anti-CMV chez les donneurs de sang de la région de Sfax (intérêt en transfusion sanguine).

Detection of anti-CMV antibodies was carried out in sera of healthy blood donors, divided into groups of 20 according to age and sex. Sera were tested for anti-CMV by an ELISA test (Enzygnost anti-CMV/IgG-Behring). Among 280 sera, 272 were positive for IgG to CMV (97.14%). The prevalence of those antibodies was high in all age stratum (95-100%) but was higher in women than in men (98.57% versus 95.71%). The titre of IgG to CMV was superior to 12 Ul/ml in 56.43% of CMV positive donors. So, the leucocyte removal is the only alternative for the prevention of post-transfusional CMV infection. The high percentage of donors with anti-CMV antibodies level more than to 12 Ul/ml allow to consider the use of plasmapheresis for preparing specific immunoglobulins to CMV.

[Viral hepatitis C in chronic hemodialyzed patients in southern Tunisia. Prevalence and risk factors]. / Hépatite virale C chez les hémodialysés chroniques dans le Sud Tunisien. Prévalence et facteurs de risque.

To define, the prevalence and risk factors of hepatitis C virus (HCV) a prospective and multicentre study was performed in 235 patients undergoing haemodialysis, the anti-HCV antibodies were evaluated using an immuno-enzymatic method (wellcozyme anti-HCV). The following parameters were obtained for all patients: time on haemodialysis, blood transfusion, liver enzymes (ALT, AST), others virus markers: HBV (HBs Ag, HBs Ab, HBc Ab) and HIV. Anti-HCV was positive in 86 patients (42%). There was a significant (p < 0.05) relationship between presence of anti-HCV antibodies and duration of haemodialysis (33 +/- 24 vs 20 +/- 19 months). No statistically significant difference was found with blood transfusion and the others parameters. In conclusion, the prevalence of HCV in our center of dialysis was high. The duration of dialysis seems to be the main risk factor.

[In vitro study of the sensitivity to antibiotics of 213 Pseudomonas aeruginosa strains isolated in an intensive care unit of the Sfax Hospital (Tunisia)]. / Etude in vitro de la sensibilité aux antibiotiques de 213 souches de Pseudomonas aeruginosa isolées au service de réanimation du CHU de Sfax (Tunisie).

Susceptibility of 213 strains of Pseudomonas aeruginosa isolated in a general intensive care unit during two years 1989 and 1990 was tested against 11 antibiotics: ticarcillin (TIC), ticarcillin+clavulanic acid (TCC), cefsulodin (CFS), ceftazidime (CAZ), imipenem (IMP), gentamicin (G), tobramycin (TOB), amikacin (AN), ofloxacin (OFX), norfloxacin (NOR) and ciprofloxacin (CIP). Antibiotic susceptibility testing was performed by disk agar diffusion test and by measuring minimum inhibitory concentrations (MICS using test agar dilution. 65% of strains were isolated from respiratory tract infections. Resistance frequency of this antibiotics was: TIC: 41.3%, TCC: 33.8%, CFS: 26.5%, CAZ: 23.2%, IMP: 11.6%, G: 72.5%, TOB: 46.5%, AN: 12.6%, OFX: 29.3%, NOR: 21.3%, CIP: 17.6%. We observed by measuring CMI that imipenem and amikacin were the most active antibiotics. From 1989 et 1990, the increase number of strains resistant to imipenem, amikacin and fluoroquinolones could be explained by massive use of those antibiotics. Besides their high level of resistance, strains isolated in intensive care unit ere characterized by their multiresistance: 24 strains were resistant to 8 of 11 antibiotics tested; four of them showed resistance to all antibiotics the multiresistance of those strains suggest strongly that decreased permeability could be the cause.