Circulating levels of FoxP3, M2 (sCD163) and IGF-1 as potential biomarkers associated with Laryngeal Squamous Cell Carcinoma in Tunisian patients.

We aim to assess the clinical impact of circulating levels of sCD163, FoxP3, IGF-1 in LSCC patients (Laryngeal Squamous Cell Carcinoma). The concentrations of sCD163, FoxP3, and IGF-1 were measured using ELISA test in the serum samples collected from 70 pretreatment LSCC patients and 70 age and sex-matched healthy controls. Statistical analysis was performed using ANOVA to compare the two groups, and the correlation between markers and clinical parameters. Receiver-Operator Characteristic (ROC) curve analysis was conducted to determine the optimal cutoff values and evaluate the diagnostic impact of these markers. Significant differences in the levels of sCD163, FoxP3, and IGF-1 were observed between LSCC patients and the control group, with respective p-values of 0.01, 0.022, <0.0001. The determined cutoff values for sCD163, FoxP3, IGF-1 concentrations were 314.55 ng/mL, 1.69 ng/mL, and 1.69 ng/mL, respectively. The corresponding area under the curve (AUC) values were 0.67 (95% CI: 0.57-0.76), 0.70 (95% CI: 0.61-0.80), 0.84 (95% CI: 0.76-0.92), respectively. Furthermore, it was found that IGF-1 concentrations exceeding 125.20 ng/mL were positively correlated with lymph node metastasis. Elevated serum levels of sCD163, FoxP3 and IGF-1 are associated with the diagnosis of LSCC. IGF-1 appears to be the most promising indicator for the LSCC progression.

Mortality attributable to tobacco in Tunisian adults, 2016Mortalité attribuable au tabac dans la population tunisienne adulte en 2016.

OBJECTIVE: We aimed to estimate the mortality attributable to current cigarette smoking among Tunisian individuals aged 30 years and over in 2016. METHODS: The number of deaths attributable to cigarette smoking was estimated using the population attributable fraction (PAF) method of calculation. Current cigarette smoking-related data and number of deaths by cause were obtained from a Tunisian national household survey conducted in 2016 (THES-2016) and the "Global Burden of Disease" study respectively. Relative risks for cause-specific mortality among current cigarette smokers compared to never-smokers were obtained mainly from the American cancer prevention study II (CPS II), including adjustments for a range of potential confounders. RESULTS: In 2016, 6,039 deaths were attributed to current cigarette smoking (5,934 in men and 105 in women), accounting for 14.3 % of total deaths in persons aged 30 years and over (24.2 % in men and 0.6 % in women). Lung cancer, chronic obstructive pulmonary diseases and upper aerodigestive tract cancers represented the highest smoking-attributable risks (74.5 %, 49.1 % and 42.2 % respectively). CONCLUSIONS: In the present study, high rates of smoking-attributable mortality were found, mainly among men. In addition to more rigorous application of existing laws, sensitization to the dangers of tobacco, educational anti-smoking campaigns and help in quitting are of prime importance.

The Prognostic Significance of IGF-1R and the Predictive Risk Value of Circulating IGF-1 in Tunisian Patients with Laryngeal Carcinoma.

The aim was to evaluate the clinical impact of IGF-1/IGF-1R in Tunisian laryngeal carcinoma. A high IGF-1R immunohistochemical expression was found in our series (81.43%). A tendency toward an association between IGF-1R expression and lymph node metastasis was found (p = 0.068). Patients with positive IGF-1R expression showed a short disease free survival (p = 0.053) and a high recurrence rate. Furthermore, circulating IGF-1 levels sera, detected by ELISA, were higher among patients compared to controls (p < 0.001). IGF-1R might have a prognostic significance and could be a factor of tumor recurrence. However, high levels of IGF-1 increase the risk of developing of LSCC disease.

Management of acute coronary syndrome in emergency departments: a cross sectional multicenter study (Tunisia).

BACKGROUND: We aimed to describe diagnosed acute coronary syndrome (ACS) and its care management and outcomes in emergency departments (EDs) and to determine related cardiovascular risk factors (CVRFs). METHODS: We conducted a cross sectional multicenter study that included 1173 adults admitted to EDs for acute chest pain (ACP) in 2015 at 14 sites in Tunisia. Data included patients' baseline characteristics, diagnosis, treatment and output. RESULTS: ACS represented 49.7% of non-traumatic chest pain [95% CI: 46.7-52.6]; 74.2% of ACS cases were unstable angina/non-ST-segment-elevation myocardial infarction (UA/NSTEMI). Males represented 67.4% of patients with ACS (p < 0.001). The median age was 60 years (IQR 52-70). Emergency medical service transportation was used in 11.9% of cases. The median duration between chest pain onset and ED arrival was two hours (Inter quartile ranges (IQR) 2-4 h). The age-standardized prevalence rate was 69.9/100,000 PY; the rate was 96.24 in men and 43.7 in women. In the multivariable analysis, CVRFs related to ST segment elevation myocardial infarction were age correlated to sex and active smoking. CVRFs related to UA/NSTEMI were age correlated to sex, familial and personal vascular history and type 2 diabetes. We reported 27 cases of major adverse cardiovascular events (20.0%) in patients with STEMI and 36 in patients with UA/NSTEMI (9.1%). CONCLUSION: Half of the patients consulting EDs with ACP had ACS. Emergency medical service transportation calls were rare. Management delays were acceptable. The risk of developing an UA/NSTEMI was equal to the number of CVRFs + 1. To improve patient outcomes, it is necessary to increase adherence to international management guidelines.

Assessment of safe injection practices in health facilities in Oman.

BACKGROUND: Unsafe injection practices put patients and providers at risk of infectious and noninfectious adverse events. A 2001 Ministry of Health survey on injection practices in Oman indicated that, while overall standards were good, in some areas there was a need for improvement. AIM: We aimed to evaluate injection safety practices to determine whether facilities meet the requirements for practices, equipment, supplies and waste disposal, and to identify unsafe practices. METHODS: We conducted a national cross-sectional survey in 2007 using the World Health Organization tool to evaluate injection safety practices. Using 2-stage cluster sampling, 80 government and 61 private health facilities were randomly selected and evaluated. RESULTS: There was no shortage of injection equipment nor evidence of attempts to sterilize disposable devices. Care providers immediately disposed of the used needle/syringe in sharps containers. Phlebotomy devices were taken from sealed packets in 96% of facilities. In private facilities, 66.3% of the care providers were fully immunized against hepatitis B. Wearing a new pair of gloves for phlebotomy was observed in only 46% of government and 38% of private health facilities. Many health facilities lacked alcohol-based handrub. CONCLUSIONS: Many injection safety aspects were satisfactory. However there are still opportunities for improvement. Actions are required to make alcohol-based handrub and appropriate sharps containers available and to provide hepatitis B vaccine and training to health care workers in all facilities.

Health screening strategies in Maghreb countries: Situation Analysis and perspectives.

BACKGROUND: The aim of screening is to improve individual health through an early detection of diseases at a stage where the prognosis of disease could be significantly. However, this kind of intervention is costly and it's necessary to respect criteria in selection of targeted diseases and screening tests. OBJECTIVE: The objective of this study was to describe public health screening policy in the Maghreb countries in order to identify the main barriers to the development of this type of intervention. METHODOLOGY: This study is a literature review of screening practices and policy in Maghreb countries. For this purpose, we conducted a global search in MEDLINE, as well as in the websites of the Ministries of Health of Maghreb countries; we also asked also key persons in the different countries to provide us useful t information concerning screening in their countries. RESULTS: Antenatal and neonatal screening is generally limited to a few pilot experiments such as screening for congenital hypothyroidism and phenylketonuria and deafness. Regarding school population, screening of certain diseases such as dental disorders, infectious diseases including tuberculosis, overweight and obesity, visual impairment, is carried out during periodic medical visits. Among adults, screening is often opportunist; it is performed in patients who use primary care health centers; the main targeted diseases are cervical, breast cancer and colorectal cancer, pulmonary tuberculosis. Screening coverage, especially for cancers, remains relatively low; for example, in Tunisia, this coverage was 12.7% for at least one cervical smear in the last five years; while for an annual clinical breast examination, this proportion was 33.2%. CONCLUSIONS: It is strongly recommended to improve coverage by screening, especially for cancers through educational actions of the population highlighting the high chances of cure in case of early detection, training of care staff and improvement, access to screening benefits.

Burden of musculoskeletal disorders in the Eastern Mediterranean Region, 1990-2013: findings from the Global Burden of Disease Study 2013.

OBJECTIVES: We used findings from the Global Burden of Disease Study 2013 to report the burden of musculoskeletal disorders in the Eastern Mediterranean Region (EMR). METHODS: The burden of musculoskeletal disorders was calculated for the EMR's 22 countries between 1990 and 2013. A systematic analysis was performed on mortality and morbidity data to estimate prevalence, death, years of live lost, years lived with disability and disability-adjusted life years (DALYs). RESULTS: For musculoskeletal disorders, the crude DALYs rate per 100 000 increased from 1297.1 (95% uncertainty interval (UI) 924.3-1703.4) in 1990 to 1606.0 (95% UI 1141.2-2130.4) in 2013. During 1990-2013, the total DALYs of musculoskeletal disorders increased by 105.2% in the EMR compared with a 58.0% increase in the rest of the world. The burden of musculoskeletal disorders as a proportion of total DALYs increased from 2.4% (95% UI 1.7-3.0) in 1990 to 4.7% (95% UI 3.6-5.8) in 2013. The range of point prevalence (per 1000) among the EMR countries was 28.2-136.0 for low back pain, 27.3-49.7 for neck pain, 9.7-37.3 for osteoarthritis (OA), 0.6-2.2 for rheumatoid arthritis and 0.1-0.8 for gout. Low back pain and neck pain had the highest burden in EMR countries. CONCLUSIONS: This study shows a high burden of musculoskeletal disorders, with a faster increase in EMR compared with the rest of the world. The reasons for this faster increase need to be explored. Our findings call for incorporating prevention and control programmes that should include improving health data, addressing risk factors, providing evidence-based care and community programmes to increase awareness.

Tuberculosis cost in tunisia.

BACKGROUND: Tuberculosis (TB) infects one third of the world population. Its economic impact is important, affecting the global economy in the World. OBJECTIVE: To determine the economic costs related to tuberculosis in Tunisia. METHODS: Calculations were made for the reference year 2013; we covered all cost components of the disease, which are related to program management, BCG vaccination, health workers training, social mobilization, screening, chemoprophylaxis, and tuberculosis care. With the exception of costs related to care, which were the subject of a specific survey, the costs of other categories were obtained from the National TB Control Program. RESULTS: The cost of the different components related to the management, prevention, screening and tuberculosis care in 2013 amounted 504688,000DT. The cost of care represented 80.0% of total costs (6807 808,000DT) ; cost related to program  management represented 13.2% (1 121 580,00 DT) and the BCG vaccination  6.0% e (512 300,00DT) The average cost per patient was 1447,360 DTin 2013. CONCLUSION: Reducing the cost of tuberculosis, would involve reducing diagnostic delay. It is also recommended to reduce hospitalization recourse, and prevent multidrug resistance which lead to additional expenditures.

Tuberculosis cost in tunisia.

BACKGROUND: Tuberculosis (TB) infects one third of the world population. Its economic impact is important, affecting the global economy in the World. OBJECTIVE: To determine the economic costs related to tuberculosis in Tunisia. METHODS: Calculations were made for the reference year 2013; we covered all cost components of the disease, which are related to program management, BCG vaccination, health workers training, social mobilization, screening, chemoprophylaxis, and tuberculosis care. With the exception of costs related to care, which were the subject of a specific survey, the costs of other categories were obtained from the National TB Control Program. RESULTS: The cost of the different components related to the management, prevention, screening and tuberculosis care in 2013 amounted 504688,000DT. The cost of care represented 80.0% of total costs (6807 808,000DT) ; cost related to program  management represented 13.2% (1 121 580,00 DT) and the BCG vaccination  6.0% e (512 300,00DT) The average cost per patient was 1447,360 DTin 2013. CONCLUSION: Reducing the cost of tuberculosis, would involve reducing diagnostic delay. It is also recommended to reduce hospitalization recourse, and prevent multidrug resistance which lead to additional expenditures.

The state of health in the Arab world, 1990-2010: an analysis of the burden of diseases, injuries, and risk factors.

BACKGROUND: The Arab world has a set of historical, geopolitical, social, cultural, and economic characteristics and has been involved in several wars that have affected the burden of disease. Moreover, financial and human resources vary widely across the region. We aimed to examine the burden of diseases and injuries in the Arab world for 1990, 2005, and 2010 using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010). METHODS: We divided the 22 countries of the Arab League into three categories according to their gross national income: low-income countries (LICs; Comoros, Djibouti, Mauritania, Yemen, and Somalia), middle-income countries (MICs; Algeria, Egypt, Iraq, Jordan, Lebanon, Libya, Morocco, occupied Palestinian territory, Sudan, Syria, and Tunisia), and high-income countries (HICs; Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates). For the whole Arab world, each income group, and each individual country, we estimated causes of death, disability-adjusted life years (DALYs), DALY-attributable risk factors, years of life lived with disability (YLDs), years of life lost due to premature mortality (YLLs), and life expectancy by age and sex for 1990, 2005, and 2010. FINDINGS: Ischaemic heart disease was the top cause of death in the Arab world in 2010 (contributing to 14·3% of deaths), replacing lower respiratory infections, which were the leading cause of death in 1990 (11·0%). Lower respiratory infections contributed to the highest proportion of DALYs overall (6·0%), and in female indivduals (6·1%), but ischaemic heart disease was the leading cause of DALYs in male individuals (6·0%). DALYs from non-communicable diseases--especially ischaemic heart disease, mental disorders such as depression and anxiety, musculoskeletal disorders including low back pain and neck pain, diabetes, and cirrhosis--increased since 1990. Major depressive disorder was ranked first as a cause of YLDs in 1990, 2005, and 2010, and lower respiratory infections remained the leading cause of YLLs in 2010 (9·2%). The burden from HIV/AIDS also increased substantially, specifically in LICs and MICs, and road injuries continued to rank highly as a cause of death and DALYs, especially in HICs. Deaths due to suboptimal breastfeeding declined from sixth place in 1990 to tenth place in 2010, and childhood underweight declined from fifth to 11th place. INTERPRETATION: Since 1990, premature death and disability caused by communicable, newborn, nutritional, and maternal disorders (with the exception of HIV/AIDS) has decreased in the Arab world--although these disorders do still persist in LICs--whereas the burden of non-communicable diseases and injuries has increased. The changes in the burden of disease will challenge already stretched human and financial resources because many Arab countries are now dealing with both non-communicable and infectious diseases. A road map for health in the Arab world is urgently needed. FUNDING: Bill & Melinda Gates Foundation.

Plasma total homocysteine: usual values and main determinants in adults living in the Great Tunis region.

BACKGROUND: Elevated total plasma homocysteine (tHcy) is an established risk factor for occlusive vascular disease and is thought to increase the risk of pregnancy loss, birth defects, and cognitive impairment in the elderly. OBJECTIVES: To determine tHcy standard values and the prevalence of hyperhomocysteinemia (HHC) and to examine their association with demographic and life style factors in the Greater Tunis population. METHODS: This cross-sectional study included 2712 subjects (1228 males and 1484 females) aged 35 - 70 years, living in the Greater Tunis region. tHcy was analyzed by a fluorescent polarizing immunoassay method. HHC was considered as tHcy > or = 15 micromol/L. RESULTS: HHC was observed in 23.7% of subjects. Plasma tHcy was higher in males than females (median (5th - 95th percentile): 13.5 [8.75 - 26.3] micromol/L vs. 10.7 [6.94 - 19.6] micromol/L). The tHcy concentration was significantly increased in smokers, alcoholics, in subjects with vitamin B12 and folate deficiencies, and hyperuricemia. In multivariate analysis, HHC was associated with male gender, vitamin B12 deficiency, clearance of creatinine, alcohol consumption, and hyperuricemia. CONCLUSIONS: HHC is common in Tunisian adults. Male gender, advanced age, renal insufficiency, low vitamin B12 status, hyperuricemia, and alcohol consumption are the main determinants of HHC in this population.

[Validity and reliability of the Tunisian version of section G of the Composite International Diagnostic Interview, relative to schizophrenia]. / Validation de la section G du Composite International Diagnostic Interview relative à la schizophrénie, traduite au dialecte tunisien.

BACKGROUND: Early diagnosis of schizophrenia can improve its outcome. Hence, screening policies should be held and suitable tools must be available for general practitioners. AIM: To translate the section G (about schizophrenia) of the Composite International Diagnostic Interview to the Tunisian dialect and to check its validity and reliability. METHODS: The Arabic version of section G of the Composite International Diagnostic Interview has been translated to the Tunisian dialect by psychiatrists speaking fluently both languages. Metric features of the instrument (sensitivity, specificity and predictive values) were assessed by checking its results against those of the gold standard i.e. the expert's opinion owing to the criteria of the Diagnostical and Statistical Manual of mental disorders 3rd revised edition. Reliability has been measured by the index of observer agreement. RESULTS: The instrument showed a low sensitivity of 45% [32% - 58%] and a high specificity of 96% [93% - 99%]. It looked as a diagnostical test that can avoid wrong diagnoses of such a serious and stigmatizing illness. These values are similar or even better than those of literature. The observer agreement index was 0.83 showing a very good reliability. The interviews mean duration was 20 minutes. The instrument showed no variability towards the sex, the age or the educational level of interviewees. CONCLUSION: Even though section G of the Composite International Diagnostic Interview failed to detect most cases with schizophrenia and showed a poor sensitivity, this instrument can be useful for screening strategies carried out by lay interviewers in the general population.

Factors Associated with Diagnostic Delays among Tunisian Breast Cancer Patients.

BACKGROUND: Breast cancer (BC) remains one of the most common and deadliest cancer among women worldwide and in Tunisia. The lethality of BC is particularly high in developing countries, such as Tunisia, due to late diagnosis in the majority of cases. The objective of this study was to analyze factors associated with delayed presentation among women followed at the Salah Azaiez institute of Tunis during the year 2021. METHODS: It was a retrospective cohort study, including patients with primary BC, consulting at the Salah Azaeiz institute of Tunis over a period of six months, from january 1st to june, 30th, 2021. The total diagnostic interval (DI) was divided into patient interval (PI) and healthcare system interval (HSI). Diagnosis delay due to patient (PD) was defined as a delay more than three months between the discovery of symptoms and the first medical consultation. Data were collected using a valid questionnaire "the breast cancer questionnaire delay" and from patients' medical records. The calculation of crude and adjusted Odds Ratios using a stepwise descending binary logistic regression model was performed to measure the association of the studied factors with the delayed presentation. RESULTS: A total, 146 patients were included. The mean age of the patients was 50.1 ± 10.9 years.  More than a half of patients had a primary education (56.8%). Majority of patients were married (86.3%) and unemployed (90.4%).  The median of patient interval (PI) and HSI were 31 days [IQR: 12.5-151.5] and 53 days [IQR: 33.0-88.7] respectively. About three quarter of patients (76.4%) presented a healthcare system delay (HSD). After univariate analysis, factors significantly associated with PD were the low level of education (illiterate/primary) (RR: 2.7; 95% CI [1.1-6.4]; p=0.02) and the lack of knowledge about BC symptoms by patients (RR: 15.0; 95% CI [6.0-37.4]; p<10-3). The only variable that remained associated with PD, after multivariate analysis, was lack of initial knowledge of symptoms (OR: 15.0; 95% CI [6.0-37.4]; p<10-3). CONCLUSION: Lack of knowledge of symptoms was the main factor associated with delayed presentation among BC women.This study shows the need to inform women about performing breast self-examination as well as clinical signs of BC.

Burden of cancer attributable to insufficient physical activity in Tunisia.

Background: Insufficient physical activity is a risk factor for several types of cancer. Therefore, estimating the burden of cancer attributable to insufficient physical activity is essential to evaluate the effect of health promotion and prevention interventions. Aims: We estimated the number of incident cancer cases, deaths and disability-adjusted life years (DALYs) attributable to insufficient physical activity in the Tunisian population aged 35 years and older in 2019. Methods: We estimated the age-specific population attributable fractions by sex and cancer site to estimate the proportion of cases, deaths and DALYs that could be avoided with optimal levels of physical activity. We used data on cancer incidence, mortality and DALYs from the Global Burden of Disease study estimates for Tunisia in 2019, and data on physical activity prevalence from a Tunisian population-based survey in 2016. We used site-specific relative risk estimates from meta-analyses and comprehensive reports. Results: The prevalence of insufficient physical activity was 95.6%. In 2019, 16 890 incident cancer cases, 9368 cancer-related deaths and 230 900 cancer-related DALYs were estimated to have occurred in Tunisia. We estimated that 7.9% of incident cancer cases, 9.8% of cancer-related deaths and 9.9% of cancer-related DALYs were attributable to insufficient physical activity. At cancer sites known to be associated with inadequate physical activity, 14.6% of cancer cases, 15.7% of deaths and 15.6% of DALYs were attributable to insufficient physical activity. Conclusion: Insufficient physical activity contributed to almost 10% of the cancer burden in Tunisia in 2019. Reaching optimal physical activity levels would considerably reduce the burden of associated cancers in the long-term.

Hospital bed capacity across in Tunisia hospital during the first 4 waves of the COVID-19 pandemic: A descriptive analysis.

Background: In March 2020, the WHO declared COVID-19 as a pandemic, and Tunisia implemented a containment and targeted screening strategy. The country's public health policy has since focused on managing hospital beds. Methods: The study analyzed the bed occupancy rates in public hospitals in Tunisia during the pandemic. The evolution of daily cases and nonpharmaceutical interventions (NPI) actions undertaken by the Tunisian Government were also analyzed. The study used 3 indices to assess bed flexibility: Ramp duration until the peak, ramp growth until the peak, and ramp rate until the peak. The study also calculated the time shift at the start and peak of each wave to evaluate the government's response efficacy. Results: The study found that the evolution of the epidemic in Tunisia had 2 phases. The first phase saw the pandemic being controlled due to strong NPI actions, while the second phase saw a relaxation of measures and an increase in wave intensity. ICU bed availability followed the demand for beds, but ICU bed occupancy remained high, with a maximum of 97%. The government's response in terms of bed distribution and reallocation was slow. The study found that the most deadly wave by ICU occupied bed was the third wave due to a historical variant, while the fifth wave due to the delta variant was the most deadly in terms of cumulative death. Conclusions: The study concluded that decision-makers could use its findings to assess their response capabilities in the current pandemic and future ones. The study highlighted the importance of flexible and responsive healthcare systems in managing pandemics.

[Medical demography in Tunisia: current situation and perspectives]. / Demographie medicale en Tunisie: etat actuel et perspectives.

BACKGROUND: Health human resources management is one of the important determinants of health care access equity. AIMS: To analyse the trend of Tunisian medical density during 2000-2009 and to predict its situation by 2024. METHODS: Current medical density was calculated using Bar Council of Physicians of Tunisia database. Medical density was calculated and analysed for the period 2000-2009 then modelled by 2024 (estimate of needs and supply). RESULTS: The active medical density raised by 36% during the period 2000-2009 with a higher increase for specialists. The proportion of non-active physicians rose from 4.6% to 15.2% in 2009. Increasing feminization of medical density and persistence of its regional disparities. By the year 2024, 217 physicians for 100,000 inhabitants would be required while the supply would correspond to 212/100 000 inhabitants. CONCLUSION: medical human resources have indeed globally improved. However, some lacks remain and adequate measures are required, based on a rational planning directed to satisfy the population needs and to allow health equity.

[Knowledge of malaria and preventive attitudes of Tunisian travellers toward malaria endemic areas]. / Connaissances du paludisme et attitudes préventives des voyageurs tunisiens vers les zones d'endémie palustre.

Introduction: travellers to endemic areas must know malaria, its risk factors and prophylactic measures. This can help to avoid severe cases of malaria and to prevent transmission in countries that are malaria-free. The purpose of this study is to assess Tunisian travellers´ knowledge about malaria, its transmission and prevention and their adherence to prophylactic measures. Methods: we conducted a survey based on two anonymous questionnaires (pre- and post-trip) among adults travelling to endemic countries. The 1st questionnaire was followed by a medical interview focusing on level of risk and recommended prophylactic measures. Results: two hundred and eighty-nine travellers were recruited. They mainly moved within sub-Saharan Africa (99%) for professional reasons (84,4%). The average age of subjects was 42.3 years and sex ratio (male/female) was 3.1. Prior to departure, only 53.3% of subjects were aware of the risk of malaria, and only 28% gave correct answers about modes of transmission. Recommendations for chemoprophylaxis were only known by 62.3% of subjects and only 43.6% intended to use chemoprophylaxis (p < 0.01). Better adherence to protective measures, including chemoprophylaxis, was reported after the trip, with attitudes qualified as good or excellent by 64.2% on return against 23.7% before the interview (<0.001). Conclusion: Tunisian travellers knowledge of malaria is insufficient. Strengthening information through specialized consultations (whose usefulness has been demonstrated) is required.

Prognostic impact of tumor-infiltrating lymphocytes in non-small cell lung carcinomas.

INTRODUCTION: Tumor-infiltrating lymphocytes represent a pivotal component of the host anti-tumor response. Thus, they considerably influence the evolution of cancers including non-small cell lung carcinomas. Even if, this important role is consensual, many discordant results are published in the literature about the prognostic role of the different populations of tumor-infiltrating lymphocytes. The aim of our work was to evaluate the prognostic impact of CD8+, CD4+, and forkhead box protein P3+ lymphocytes in the tumor microenvironment of non-small cell lung carcinomas. METHODS: We conducted a retrospective descriptive study, which included non-small cell lung carcinomas diagnosed in the department of pathology and followed in the medical oncology department of the same hospital between 2011 and 2015. Tumor-infiltrating lymphocytes were analyzed by the immunohistochemical method for forkhead box protein P3, CD4, and CD8. Intratumoral and stromal-labeled lymphocytes were quantified by manual counting at high magnification (×400). Forkhead box protein P3+/CD8+, forkhead box protein P3+/CD4+, and CD8+/CD4+ ratios were subsequently calculated. The prognostic value of tumor-infiltrating lymphocytes was assessed in respect of overall survival, recurrence-free survival, and relapse-free survival. RESULTS: Thirty-nine patients were included. The mean age of patients was 59.6 years. A complete surgical resection (p = 0.009), and a CD8/CD4 ratio (p = 0.008) were prognostic factors for overall survival. Complete surgical resection (p = 0.003), the forkhead box protein P3/CD8 (p = 0.005), and forkhead box protein P3/CD4 (p = 0.037) ratios were prognostic factors for recurrence-free survival. The CD8+ tumor-infiltrating lymphocytes rate (p = 0.037) was a prognostic factor for relapse-free survival with a threshold of 67.8/high power field. Microscopic subtype (p = 0.037) was a prognostic factor for relapse-free survival when only adenocarcinoma and squamous cell carcinoma were considered. In multivariate analysis, age (p = 0.004) and a CD8/CD4 ratio (p = 0.016) were independent predictors of overall survival. CONCLUSION: Despite the limitations of our study, our results confirm the prognostic value of tumor-infiltrating lymphocytes in non-small cell lung carcinomas and the importance of the combined quantification of their different subpopulations.

[Opinion of the Population of Tunis about the physician social image]. / La Place du médecin dans la société selon la perception de la population résidant dans le gouvernorat de Tunis.

BACKGROUND: The image of the Tunisian doctor seems to have lost some of its aura and social value. AIM: To evaluate the medical profession's social image and to identify the reasons of a possible dissatisfaction by interviewing a sample of 200 adults in the District of Tunis. METHODS: Population was selected according to the method of quotas depending of sex, age and instruction degree. One hundred and ninety nine persons aged 20 years and above were included. Collection of data was made by an interview and included 4 items: identification of respondent, expected qualities of medical doctor, satisfaction level regarding health services, comparison between general medicine and specialists. Chi-2 test was done for comparison of proportions. In order to classify professions according to income and prestige a score was calculated. It ranged from 10% (10th rank) to 100% (1st rank). RESULTS: Patience and availability were quoted as particularly essential requirements in a doctor. Yet only 35.7% of the interviewees reported being satisfied by their doctor's qualities. A general dissatisfaction regarding health services was also noted. Our sample's perception of professional prestige rated industrials over doctors by placing them in first position. With regards to the perception of best-paid jobs, doctors were classed third after industrials and important traders. CONCLUSION: In order to counter these deficiencies and to preserve doctors' social image and their place in society, it is imperative to change our understanding of their training and recycling and also to improve their purchasing power as it is the unquestionable guarantee of the preservation and durability of their public image.