[Analysis of severe Legionellosis hospitalized in intensive care units in Tunisia]. / Analyse des cas de légionellose grave hospitalisés dans les services de réanimation en Tunisie.

This study is the first one that describes the situation of Legionnaires' disease (LD) in Tunisia, with its clinical and epidemiological characteristics and investigates the risk factors associated with Legionella infections in our country. We conducted a retrospective multicentric study during 5 years (2008-2012) concerning all confirmed LD cases in Tunisia and we investigated risk factors for infection. The total of confirmed LD cases was 14. Incidence was 0.03. Mean age: 53.1, sex ratio (M/F): 2.6. Summer-autumnal peak was noted. Risk factors for infection were: the great humidity at home (n=4), living in community (n=3) and practice ablutions (before prayer) in public places (n=4). Community acquired legionellosis (n=9) and nosocomial (n=2). Pulmonary symptoms (n=11)+/-gastrointestinal (n=6) and/or neurological signs (n=4). Beta lactams therapy failed (n=11). CXR showed bilateral lesions (n=6). Abnormalities in laboratory values were noted: hyponatremia (n=9), high CPK levels (n=9). Diagnosis was confirmed by positive urinary Legionella antigens test (n=10) and by direct immunofluorescence (n=1). Treatment was based on bitherapy (n=10). Five patients died. The incidence of LD appears lower than other countries. Some risk factors, as ablutions, are different from that reported in Western countries and seem to be specific to our society. Given the seriousness of its consequences, it is strongly recommended to improve the national surveillance system up and register LD as notifiable disease.

[Post-cesarean parietal scar characteristics are predictive of pelvic adhesions. A prospective cohort study]. / Les caractéristiques de la cicatrice pariétale de césarienne sont des facteurs prédictifs des adhérences pelviennes. Étude de cohorte prospective.

OBJECTIVE: To investigate whether abdominal scar characteristics could predict the incidence and severity of intra-abdominal adhesions found at repeat cesarean delivery. PATIENTS AND METHODS: Prospective cohort study including 151pregnant women with at least one previous cesarean delivery and who delivered abdominally in the department of obstetrics and gynaecology of Farhat Hached teaching hospital-Sousse-Tunisia, during 6 months. Abdominal scar characteristics were studied. The main outcome measure(s) were the incidence and severity of intra-abdominal adhesions. Statistical analysis was performed using SPSS 18.0. RESULTS: Of 151 women enrolled into this trial, 111 (73.5%) had adhesions, 57 (37.8%) had dense adhesions. Of all the abdominal scar characteristics studied, a depressed scar was associated with an increased incidence of both dense and filmy intra-abdominal adhesions and frozen pelvis if compared of women who did not have a depressed scar (P<10(-4) ; RR=7.6; IC=2.98-19.45). A number of previous cesarean section equal or more than 2 was also correlated with an increased incidence of severe intra-abdominal adhesions and frozen pelvis if compared with women who had only one previous cesarean section (P=0.002; RR=2.53; IC=1.16-5.56). DISCUSSION AND CONCLUSION: A depressed abdominal scar of a previous cesarean delivery and a number of previous cesarean sections are significantly correlated with the incidence and severity of intra-abdominal adhesions.