Introduction. - The recent validation of "Fenniche' questionnaire", designed to assess the level of knowledge about occupational asthma, written in Tunisian dialect Arabic, was a real step towards conducting studies on this topic in Tunisia. Aims. - To validate the French version of "Fenniche' questionnaire". Methods. - A cross-sectional study was conducted between May and August 2022 on a representative sample of students from the Faculty of Medicine of Sousse selected by convenience. Translating the questionnaire was carried out in accordance with the standard process for translation and cross-cultural adaptation. Results. - We gathered 325 data collection forms. Statistical analysis showed that education level and female gender were correlated with significantly higher mean total scores. The internal consistency coefficient (Cronbach's Alpha) for the translated version was equal to 0.720, indicating satisfactory reliability. Principal component factor analysis proved the construct validity of the auto-questionnaire. Conclusions. - Through this study we provided a validated French version of this instrument. This will lead to its wider use among French-speaking populations.

Background Accessibility to internet has allowed people to have a better knowledge of Systemic lupus erythematosus (SLE), however, this interest in doing research is influenced by several factors, including socio-economic conditions. Google Trends (GT) is the most popular tool for examining online behavior because it provides information regarding trends and changes in online interest at certain times during a particular period. Objectives The aim of this study was to use the Google Trends data to evaluate the public interest in Systemic lupus erythematosus (SLE) in different African countries and to assess people's interest in Africa comparing to worldwide. Methods Google Trends provides the relative interest of Google Searches (RSV), on a range of 0–100. We analysed a large amount of data generated by Google Trends concerning the search of the word ‘lupus’ in a 7-year web-based research (2016-2022) in Africans' countries. Student's t-test was used to compare means. Analyses were performed with SPSS 21.0. P values less than 0.05 were considered statistically significant. Results Googling “lupus” was variable depending on the country. The mean annually research volume (RSV) in Africain countries was 18.20±3.92. Annual RSV was more important in Morocco50.89±16.52, Algeria 49.19±23.84. There was a significant difference in the mean annually research volume between African countries and all over the word (versus 50.86± 14.58, p<10-3). (Figure1) Conclusion Google Trends allows us to find useful information about SLE on the internet. However lack of internet coverage, low socio-economic level and low education level can explain this difference between African countries and the rest of the world. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests None Declared.Figure 1Search volume of lupus variation in African Countries Versus all over the world s from 01.01.2016 to 01.09.2022

De nombreuses recherches ont été menées afin d'évaluer les troubles mentaux notamment chez les adolescents. Ces troubles sont la première cause d'invalidité dans le monde et peuvent même conduire au suicide. Dans notre pays, les recherches portant sur cette problématique sont encore rares. L'objectif de notre étude était de déterminer la prévalence de la dépression, de l'anxiété et de mesurer le score d'estime de soi chez les adolescents. Nous avons réalisé une étude transversale dans la délégation d'Enfidha du gouvernorat de Sousse en Tunisie chez les collégiens et les lycéens. La collecte des données a été effectuée au cours de l'année scolaire 2019/2020. Un questionnaire structuré auto-administré a été utilisé dans ce but. Il comprenait les caractéristiques sociodémographiques, les comportements de style de vie et le dépistage des troubles mentaux suivants : la dépression (échelle « Beck Depression Inventory-II »), l'anxiété (le » Screen for Child Anxiety Related Disorders » (SCARED-C)) et la mesure du score d'estime de soi (« Rosenberg Self-esteem Scale »). Nous avons recruté les participants à l'étude par échantillonnage proportionnel avec une stratégie de sélection en grappes pour obtenir un échantillon représentatif. Un total de 1352 participants a été inclu dans l'étude avec un âge moyen de 16,07 ans (SD : 1,97). Les femmes représentaient 56 % de l'échantillon. Près de 40 % des participants ont redoublé au moins une fois (39,3 %). La dépression, tous stades confondus, a été signalée chez 79,1 % des adolescents. Les filles étaient plus enclines à être sévèrement déprimées (73,3 % contre 26,7 %) ; p<0,005. Concernant l'anxiété, plus de la moitié des élèves souffraient d'une anxiété certaine (51,3 %) avec une prédominance féminine (68,5 %). Nos résultats soulignent que 49,7 % des participants ont un faible score d'estime de soi. Il est crucial de répondre aux besoins des adolescents souffrant de troubles mentaux. La priorité doit être donnée dans la politique de santé publique à ce fléau via la promotion et le dépistage précoce. Adolescent, Santé mentale Les auteurs n'ont pas précisé leurs éventuels liens d'intérêts.

Le diabète type 2 pose le problème crucial de l’observance thérapeutique ; concept large associé à plusieurs facteurs. On a mené cette étude descriptive auprès des patients suivis pour diabète type 2 dans un hôpital de circonscription du centre tunisien pour déterminer leur niveau d’observance thérapeutique et les facteurs qui lui sont associés. Nous avons mené une étude transversale à visée analytique en utilisant un questionnaire élaboré pour les fins de cette étude et ayant inclus le questionnaire de Morisky à 8 items. L’observance ou l’adhésion thérapeutique ont été définies par un score ≥ 6 au questionnaire Morisky et l’équilibre glycémique a été défini par une HbA1c < 7 %. Nous avons inclus dans notre étude 50 patients diabétiques type 2 suivis à la consultation des chroniques de l’hôpital Mahdia. Un âge moyen était de 63,10 ± 10,72 ans. L’ancienneté du diabète était de 10,4 ± 7,12 ans. Dans notre population, seulement 54 % des patients étaient retrouvés observants pour leur traitement antidiabétique. Parmi les facteurs étudiés, seule la prise de traitements à type sulfamide était associée significativement à l’observance thérapeutique (p = 0,01). Optimiser l’observance dans le diabète contribue en effet à diminuer les complications de la maladie et les hospitalisations, améliore la qualité de vie des patients, et permet de diminuer les dépenses de santé. Nous étions limités par la taille faible de l’échantillon vu les circonstances de COVID-19. Des programmes multidisciplinaires pour l’éducation thérapeutique à l’échelle nationale et régionale seraient utiles pour améliorer l’observance thérapeutique chez les patients diabétiques.

Le cyber-harcèlement scolaire constitue un grave problème de santé publique et d'éducation. Les adolescents ont un risque plus élevé de subir la cyber-harcèlement en tant que victime étant donné la fréquence de leur utilisation d'Internet via des sites de réseaux sociaux tels que Facebook et des appareils mobiles tels que les téléphones portables et les tablettes. La victimisation par cyber-harcèlement est répandue dans le monde atteignant des taux de prévalence allant jusqu'à 15 %. La connaissance des facteurs de risque de ce cyber-harcèlement chez les collégiens est cruciale pour la mise en œuvre les mesures préventives adéquats. Cette étude vise à déterminer la prévalence du cyber-harcèlement chez les collégiens de la région d'El Kef (Tunisie) et d'identifier ses facteurs associés. Une étude transversale à visée analytique a été conduite auprès d'un échantillon en grappe de collégiens de la région d'El Kef. Un questionnaire auto-administré a été utilisé pour recueillir les caractéristiques sociodémographiques et éducatives des participants. L'échelle d'Olweus Bully/Victim révisée (OBVQ-R) a été utilisée pour évaluer la prévalence et les formes de victimisation par harcèlement. Un modèle de régression logistique binaire a été utilisé pour identifier les facteurs associés au fait d'être victimes de cyber-harcèlement. Au total, 1111 collégiens âgés de 11 à 17 ans (moyenne d'âge 13 ans (SD=1,03)), ont participé à l'étude. Cet échantillon était composé de 472 garçons (42 %) et de 639 filles (58 %). La prévalence de la victimisation par cyber-harcèlement était de 14,3 %. Au terme de l'analyse multivariée, deux facteurs ont été retenus comme associés à la victimisation par cyber-harcèlement (tableau 1). En fait, les filles étaient plus à risque de cyber-harcèlement que les garçons (OR=1,67 ; CI 95%=[1,14-2,37]). Alors que les non redoublants semblent être protégés contre le cyber-harcèlement (OR=0,29 ; CI 95%=[0,20-0,43]). (tableau 2). Le cyber-harcèlement est une expérience fréquente chez les collégiens tunisiens. Ces résultats s'ajoutent aux données empiriques sur la victimisation par cyber-harcèlement et renforcent le besoin urgent de prévention du cyber-harcèlement en Tunisie. En outre, du point de vue de la pratique, il est important d'accroître notre sensibilisation au cyber harcèlement et de réduire ses facteurs de risque. Cyber-harcélement , Victimisation , Adolescents , Milieu scolaire Les auteurs n'ont pas précisé leurs éventuels liens d'intérêts.

L'épuisement académique ou « burnout » (BO) chez les étudiants en médecine sollicite de plus en plus de l'intérêt en recherche en éducation médicale. Il a un impact négatif important sur les étudiants en médecine et sur la qualité de leurs services. Cela pourrait nuire à leur développement professionnel, affaiblir leurs qualités personnelles et professionnelles, et engendrer des problèmes tels que l'accroissement des erreurs médicales et la réduction de la qualité et de la satisfaction des patients. Cette étude vise à étudier les effets du stress perçu, des caractéristiques socio démographiques et académiques et des habitudes de vie des étudiants en médecine sur l'épuisement académique. Une étude transversale à visée analytique a été menée à la Faculté de médecine de Sousse (Tunisie), auprès des étudiants de 1ère, 2ème, 4ème et 5ème années. Un questionnaire auto-administré a été utilisé pour recueillir les caractéristiques sociodémographiques et académiques, ainsi que les habitudes de vie des participants. L'échelle de « Maslach Burnout Inventory » (MBI-SS) à 15 items dans sa version pour les étudiants a été utilisée pour évaluer le niveau d'épuisement académique. De plus l'échelle de stress perçu (« Perceived Stress Scale », PSS) à 10 items a été utilisée pour évaluer le niveau de stress perçu. Une régression linéaire hiérarchique a été effectuée pour explorer les effets du stress perçu, des caractéristiques socio démographiques, les caractéristiques académiques et les habitudes de vie sur l'épuisement académique Au total, 703 étudiants âgés de 18 à 31 ans (moyenne d'âge 21 ans±1,84), ont participé à l'étude. Cet échantillon était composé de 499 filles (70,98 %) et de 204 garçons (29,01 %). Au terme de l'analyse multivariée, le stress perçu était positivement associé à l'épuisement académique (épuisement émotionnel (EE) : ß=0,36, p<0,001 ; cynisme : ß=0,41, p<0,001 ; efficacité professionnelle : ß= -0,34, p<0,001). Alors que, le niveau d'étude avait un effet positif sur l'épuisement émotionnel et le cynisme : plus le niveau d'étude augmente, plus les niveaux d'EE (ß=0,16, p<0,001) et cynisme (ß=0,07, p<0,001) augmentent. Par ailleurs, la consommation d'alcool semble accroitre le niveau de cynisme (ß=0,069, p=0,05), mais réduire le niveau d'efficacité académique (ß=-0,09, p=0,01). Quand au niveau d'éducation du père, il avait principalement un effet positif sur l'épuisement émotionnel. En effet, plus le père est éduqué, plus le score d'EE est important (ß=0,12, p=0,001). Au final, les étudiants redoublants avaient un score d'efficacité académique plus faible que les non redoublants (ß=-0,1, p=0,004). Le stress perçu était un fort indicateur d'épuisement académique. De plus, les étudiants en médecine ont un risque accru de développer un BO durant leurs années d'études, ce qui pourra se répercuter négativement sur leur carrière et leur relation avec leurs patients. De nombreuses interventions doivent être instaurées visant à améliorer notamment l'environnement éducatif et de pratique des étudiants en médecine. Stress perçu, Epuisement académique, Etudiants, Médecine Les auteurs n'ont pas précisé leurs éventuels liens d'intérêts.

Abstract Background The risk of substances use increases during adolescence. In Sousse (Tunisia), an upward trend of these risk behaviors has been observed during the last years among young adolescents. Among older adolescents, the trend of their use is unknown. Objectives To determine the incidences and the most influencing factors on substances use among high school students in Sousse between 2018 and 2019. Methods A prospective longitudinal study was conducted among a cohort of high school students from Sousse. The same pre-tested questionnaire served to collect data in 2018 and 2019 from the same participants in their classes and in the presence of pre-trained investigators. Results A total of 404 high school students have participated in the study. Their median age was of 17 (IIQ: 15.8-17.6) years. Girls represented 66.8% of participants. The incidence rates of lifetime tobacco use, alcohol consumption, lifetime inhalants use and lifetime illicit substances use between 2018 and 2019 were 13%, 3.5%, 1.8% and 2 .9% respectively. Lifetime tobacco use was the main predictor of inhalants experimentation. This latter was the main predictor of becoming a user of e-cigarettes while alcohol consumption was the most influencing factor on cannabis experimentation among high school students. On the other hand, illicit substances use among friends predicted e-cigarette use, alcohol consumption, and cannabis experimentation among participants. Conclusions The existing prevention programs aiming at reducing tobacco use and substances use in the schools of Tunisia should be reinforced and integrate a comprehensive and multi-sectoral prevention program. The implementation of a national observatory of substances use would ensure the continuous improvement of this program. Key messages • There is an upward trend on using substances among the adolescents of Sousse, Tunisia. • Tobacco experimentation and alcohol consumption are the gateway to later substances experimentation among the adolescents of Sousse, Tunisia.

Abstract Background and aim Bullying is a complex and widespread public health issue that one can be exposed to at any age and at any field, but it is considered particularly frequent during times of transition in children’s and adolescents’ lives. This study aims to investigate the prevalence and various forms of bullying victimization and explore culture of bullying victimization among students. Methods A cross-sectional study was conducted during the Academic year 2018/2019 among middle school students in the governorate of El Kef, Tunisia. The sampling method adopted for this research was a cluster sampling technique. Data were collected using self-administered questionnaires. The Students’ involvement in bullying victimization was assessed using a validated Arabic version of the revised Olweus Bully/Victim Questionnaire. Results A total of 1111 middle school students were enrolled. The prevalence of bullying victimization behavior in this study was 45.8 % [95% CI: 45.5- 46]. Looking at the forms of bullying experienced by students: “Being called mean names” was the most prevalent form of being bullied with 26.9% (n = 299), followed by 16.9% reported “being kicked in some place”, 16.3% reported “being bullied through false rumors” and 14.3% experienced bullying through messages, calls or images by means of mobile phones or Internet and 8.1% of the students reported being bullied with sexual gestures or comments. Verbal bullying (29.5%) was the most common type of victimization, followed by physical victimization, relational victimization and cyber victimization with 22.5%, 22.2% and 14.3% respectively. More than half of the students (58.5%) were more likely to inform others about incidents of bullying in their schools, mainly their parents (36.6%) or a friend (32.6%). Conclusions Bullying is serious and major public health issue that have a negative impact on adolescents’ well-being, and require special attention at the family, school, and community level Key messages • High prevalence of bullying victimization with predominace of verbal type. • Culture of bullying victimization and taking care of victims is still weak.

Abstract Background Smoking is the leading cause of preventable death. This risk behavior usually begins during adolescence. However, only the third of the countries are monitoring this risk behavior among adolescents. Objective To assess the prevalence of tobacco use and to determine the predictors of its experimentation among high school students from Sousse (Tunisia) in 2018 and 2019. Methods In 2018 and 2019, two cross-sectional studies were led among 1399 and 1342 adolescents randomly selected from the same four high schools in Sousse. For data collection, the same pre-tested questionnaire was self-administered anonymously to the participants in the presence of pre-trained investigators. Results Girls represented 60.5% and 63.2% of participants in 2018 and 2019 respectively. The prevalence of tobacco experimentation was of 29.4% in 2018 and of 26.7% in 2019. Current cigarette smoking was objectified in 9.8% and 7.4% of participants in 2018 and 2019. Regardless of the year of the study, the main predictors of lifetime tobacco use among them were: current use of e-cigarette (adjusted OR of 6.4 [4.5-9.0]), cannabis experimentation (adjusted OR of 5.3 [2.7-10.7] and alcohol consumption (adjusted OR of 3.9 [2.5-6.3]). Conclusions Experimentation and current use of tobacco are common among the high school students of Sousse. The national smoking prevention program should be reinforced by multisectoral prevention actions targeting not only tobacco use but also the consumption of other substances. Key messages • Tobacco experimentation is high among the adolescents of Sousse. • Tobacco experimentation is strongly associated with other substances use among the adolescents of Sousse.

Abstract Introduction Diabetes mellitus is a growing public health concern. Despite compelling evidence about the effectiveness of medications, studies have indicated that less than 50% of patients achieved therapeutic targets. The aim of this study was to assess the adherence to type 2 diabetes mellitus treatment and its determinants. Methods A cross-sectional study was conducted between April and June 2017 in the Endocrinology and internal medicine departments of Farhat Hached University Hospital in Sousse, Tunisia. A convenient sample of patients who fulfilled the eligibility criteria was recruited. A pre-tested questionnaire was used to gather information. This was followed by assessing patients' adherence to diabetes medications using the eight-item Morisky Medication Adherence Scale (MMAS-8). Results A total of 330 patients with Type 2 Diabetes Mellitus participated in this study. The mean ±SD age of patients was 58.96±10.3 with female predominance (60.3%). More than half of participants were with high cardiovascular risk. In most cases (70.6 %), participants were moderate adherent. Results showed that patients become non-adherent as the disease gets older (p = 0.001). In addition patients with health insurance were significantly more adherent comparing to those who did not have it (p = 0.01). Regarding self-care practices and other metabolic risk factors' effects, our data revealed that exercising 30 minutes below than 5 times in week and poor self-management of diet were associated with low adherence (p < 10-3). On the other hand, patients who have started insulin therapy were less adherent than those who had not yet (0.01). Patients with diabetic retinopathy or maculopathy were significantly more prone to be non- adherent, with respective percentage of 39.1% and 37.5%. Conclusions This study provides insights into the determinants of non-adherence, ultimately guiding the effective interventions through development of structured long-term policies not yet implemented. Key messages In most cases (70.6 %), participants were moderate adherent. Patients with diabetic retinopathy or maculopathy were significantly more prone to be non- adherent.

Adolescence is a period of significant and rapid development, marked by the growing influence of peers, individual behavioral choices and increased risk taking, including addictive behaviors. Furthermore, association between these behaviors and mental health disorders such as anxiety, depression and low self-esteem, has been demonstrated in literature. In accordance with this need, we conducted this study to determine the prevalence of addictive behaviors and screen for mental disorders among adolescents. We conducted a cross sectional study in Enfidha (a town in the Sousse governorate; Tunisia). The setting of the study was in high and middle schools. Data collection was done during January and February 2020. A structured self-administered questionnaire was used in this aim. It included socio-demographic characteristics, screening for mental health problems and addictive behaviors (self-esteem, depression, anxiety, facebook addiction and video game addiction). The scales are self-report validated instruments. We included 1195 participants with a median age of 14 years (IQR 13-16). Females represented 54.2 % of the sample. Concerning depression and anxiety, it was reported among 71.3%, 62.4% of participants, respectively. We noted that self-esteem was low among 49.5% of respondents. The pooled prevalence of internet gaming disorder and Facebook addiction was 37.4% and 32.3%, respectively. Our finding yield that girls were more prone to be Facebook addict. Meanwhile, internet gaming disorder was more common among boys. Regarding tobacco and alcohol use, it was reported among 16.7% and 3.2% of students, respectively. Our results pointed out that illicit substances' experimentation was disclosed among 2.1% of our sample. Our study is one of rare and recent research in our country interesting the striking issue of addiction and mental health disorders among adolescents. Tobacco and alcohol use was reported among 16.7% and 3.2% of students. Illicit substances’ experimentation was disclosed among 2.1% of our sample.

Abstract Background Childhood asthma still imposes a substantial burden on the health care system and community. Its management requires a significant direct cost. Several factors can influence the cost of asthma management, particularly severe asthma. There is scant information about the predictors of asthma-related cost. Thus, the purpose of this study was to estimate direct asthma-related cost among children with chronic asthma and to identify factors that have the greatest contribution to change it. Methods This cross-sectional study was carried out in Farhat Hached University Hospital in Sousse (Tunisia, Africa) over a period of three months (April-June 2018) among children with asthma aged 7-17 years. The direct cost was defined as the costs of health resources utilization and medication related to asthma in the past 12 months. Purchasing power parity technique was used to convert TND to USD. Multiple linear regression was performed to examine the association between dependent and independent variables. Results A total of 90 subjects participated in the study. The mean age was 9.81±2.56 and 55.6% were male. The annual mean of the total direct cost was USD 616.71±454. Multivariate analysis showed that the severity of asthma, inhalation technique and emotional domain of QOL predict asthma cost and that the latter was the best predictor (p = 0.005, p = 0.03, p = 0.004, respectively). This data indicates that for one child with mild asthma, correct inhaler technique, and moderate impairment of emotional function QOL domain, estimated asthma direct cost was equal to 1035.21 USD per 12 months. Conclusions This study showed that higher severity of asthma, incorrect inhaler technique and a lower score of emotional function increased direct cost related to asthma. These results are useful for health care providers and community since they provide information about the impact of modifiable risk factors on direct asthma cost. Key messages For one child with mild asthma, correct inhaler technique, and moderate impairment of emotional function QOL domain, estimated asthma direct cost was equal to 1035.21 USD per 12 months. Higher severity of asthma, incorrect inhaler technique and a lower score of emotional function increased direct cost related to asthma.

Throughout recent years, Workplace violence in hospital emergency departments has become common problem. Thus, rate of emergency departments workers who are experiencing it is increasing significantly especially since Tunisian revolution. Closely related to reduced job satisfaction and performance. The objective of this study was to have an overview the characteristics of Workplace violence against workers in emergency departments in a secondary healthcare center in Tunisia. We conducted a cross-sectional study in the emergency department in Sidi Bouzid Hospital. The study investigated all types of violence against Emergency department workers including physicians, nurses, admission/registration personnel and security officers. Assaults that occurred during the year of study were included. Data were collected from registers, medical certificate files and interviews with aggressor and aggrieved from October 2014 till October 2015. Socio-demographic characteristics of both of them as well as types of violence were recorded. Data were verified and analyzed using Statistical Package for Social Science (SPSS), software version 18.0. A total of 110 participants were enrolled: 27 (25%) physicians, 45 nurses (41%), 16 security officer (14%), 18 workmen (16%) and 4 administrative personnel (4%). The majority (56%) experienced at least one type of work place violence in the past 12 months: 29% exposed to physical violence, 41% to non-physical assaults or verbal abuses and 30% experienced both types of violence. Males were more prone to violence than females (61% vs. 31%). Same results were reported regarding type of violence (physical/verbal). In fact, in either types men were more concerned but insignificant statistically (P = 0.86). Regarding aggressors profile, our results showed that they are mostly males (77%) with a mean age of 36 years (± 12). They were dunk/intoxicated and suffering from mental disorders in 47% and 12% among all cases, respectively. Violence against workers in emergency departments is highly common. All categories are affected. Neither men nor women are exempted even if our results concluded a male predominance. All stakeholders should collaborate in order to prevent and tackle this problem.

Diabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. It is considered a major public health problem with significant social and economic consequences. Yet, it continues to have an upward trend worldwide. Acute complications of diabetes remain relatively frequent, for which these patients continue to consult the emergencies. It can lead to increase morbidity and mortality if not efficiently and effectively treated. The aim of this work is to specify the epidemiological and some clinical characteristics of patients consultants at the emergency department of the university hospital center Farhat Hached of Sousse (Tunisia) for acute complications. We conducted a prospective study of 168 consecutive patients who were admitted to emergency department at the Farhat Hached University Hospital Center, Sousse, Tunisia between January 2016 and July 2016 for acute decompensation of diabetes and whose age is older than 15 years. We included the five types of acute complication diabetic has to know: the hyperglycemia, hypoglycemia, the hyperglycemic hyperosmolar state, the ketosis and the ketoacidosis. Study was performed using a pre-tested questionnaire completed by the doctor at emergency department. Main sources of data were patients’ medical records, anamnesis and clinical examination. Variables measured were related to: patients’ general characteristics, clinical profiles, etc. For each estimate, a confidence interval was calculated according to the conventional formula. When the application conditions of the conventional formula were not met, the Wilson procedure with continuity correction was used. The mean age of patients was 45 ± 17.7 years. Almost 83.9% of them were under the age of 65 years with extremes ranging from 16 to 87 years and predominately female (53.6%). Among all cases, 35.7% reported that they fortuitous discovered that they are diabetic versus 64.3% who are already diagnosed with diabetes. According the type of diabetes, we noted that type 1 diabetes mellitus (T1DM) were more frequent than type 2 (T2DM) (59.25% versus 40.75%), 71 patients (65.74%) were treated by insulin including 27 patients with T2DM. The proportions of acute complications in decreasing order were ketosis (36%), ketoacidosis (30%), hyperglycemia (25%), hypoglycemia (25%) and finally hyperglycemic hyperosmolar state (2%). Concerning hypoglycemia, it was significantly predominant in T1DM (P = 0.004). Thus, no cases of lactic acidosis has been noted in our cohort. The major reasons of consultations were no specific one such as fever, chest pain (25.6%) and deterioration of general status (20.8%). Inaugural diabetes and poor compliance to treatment were mostly the precipitating causes of acute complications with percentages of 32.2% and 31.6%, respectively. Furthermore, anamnesis and clinical examination revealed that 37.9% of patients were at degenerative complications stage. One case of death at emergency was reported. Diabetic Ketosis and ketoacidosis are still frequent complications and commonly encountered medical emergencies among patients with diabetes mellitus. Hypoglycemia is significantly more observed with T1DM. Henceforth, diabetes and its complications are preventable. More emphasis is required in order to decrease the prevalence of diabetes and to improve the prognosis in the short- and long-term. This concern should be shared by all healthcare providers and not be limited only to clinical experts.

Background: In spite of the epidemiological transition, communicable diseases remain a public health problem and represent a significant cause of morbidity and mortality worldwide, especially in developing countries. This study aimed to determine the crude and standardized prevalence rates of hospitalizations for communicable disease (HCD) and to assess trends in HCD by age and sex at a university hospital in Tunisia over a period of 12 years (2002-2013).Methods: All cases of HCD from 2002 to 2013 in the university hospital departments were included. Data collected from the regional register of hospital morbidity were used. The discharge diagnoses were coded according to the International Classification of Diseases, 10th revision (ICD-10).Results: HCD represented 17.45% of all hospitalizations during the study period (34 289/196 488; 95% confidence interval 17.28-17.62%). The median age at the time of admission was 31 years (interquartile range (IQR) 15-52 years). The median hospital length of stay (LOS) was 5 days (IQR 3-9 days). The crude prevalence rate (CPR) was 5.41 per 1000 inhabitants. The CPR was highest among patients aged >= 65 years. The four communicable disease categories that represented 70% of all HCD were abdominal infection, skin infection, genitourinary infection, and lower respiratory tract infection. The majority of HCD decreased over time; however, there was a significant increase in HIV diseases, tuberculosis, and viral hepatitis.Conclusion: This study provides evidence of the epidemiological transition, showing a decline in communicable diseases, which needs to be sustained and improved. (C) 2017 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.

Background: The penicillin therapy of beta hemolytic streptococcal pharyngitis has aided in the decrease of rheumatic heart disease (RHD) in developing countries. Tunisia is an endemic area, however, and incidence of RHD is weakly documented. We aimed at establishing the standardized incidence rate (SIR) of RHD in Monastir governorate and at determining RHD prevalence among hospitalized patients in two cardiology departments.Methods: From the regional register of Monastir Hospital morbidity, we have selected newly diagnosed patients with RHD, residents of Monastir, and hospitalized to the 2 cardiology departments between 2000 and 2013 (2001 not included).Findings: We studied 676 newly admitted patients. We estimate 1060 to be the number of new annual RHD cases in Tunisia. The SIR per 105 person-years was 10.97, being 9.3 in men and 19.1 in women, respectively. We have notified a negative trend of crude incidence rate/10(5) Inhabitants (Inh) (CIR) (r= -0.23, p < 10(-3)), and a strong positive correlation between age and CIR/10(5) Inh (r = 0.989, p < 10(-4)). RHD lethality was 1%. We have registered 728 hospitalizations for RHD, representing 2.5% of all cardiology hospitalizations [95% CI: 2.3-2.7%], with a prevalence for 13.3% for women aged 15-29 years. The median hospital stay was 9 days (IQR: 5-15).Conclusion: Our results confirm the RHD incidence decrease, consistent with epidemiological transition in Tunisia. We have also emphasized on the close trend of RHD with age and the predominance of RHD among women especially at the procreation age. (C) 2016 Elsevier Ireland Ltd. All rights reserved.