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Abstract: Acquiring rubella during the first 20weeks 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 20years. 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 18years 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. [Copyright &y& Elsevier]

Summary: 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. [ABSTRACT FROM AUTHOR]

Introduction Les indications du traitement de l’hépatite virale chronique B reposent sur l’évaluation des transaminases, de l’ADN viral et du degré de sévérité de l’atteinte hépatique. La ponction biopsie du foie (PBF), bien qu’il s’agisse d’un test invasif, demeure l’examen de référence pour l’évaluation des lésions histologiques. Chez les patients ayant un taux de transaminases normal et un taux d’ADN entre 2000 et 20 000 UI/mL, l’indication de la PBF ne fait pas encore l’unanimité. L’objectif de notre travail est d’évaluer l’intérêt de la ponction biopsie du foie, dans un but pré-thérapeutique, chez ces patients. Patients et méthodes Il s’agit d’une étude rétrospective menée, dans un service d’hépato-gastroentérologie, sur une période de 7 ans (2008–2015). Tous les patients suivis d’une hépatite chronique virale B avec un taux de transaminases normal, ayant une virémie entre 2000 et 20 000 UI/mL, et ayant bénéficié d’une PBF ont été inclus. Ces patients ont été séparés, selon les données de la PBF, en deux groupes (groupe traité : ceux ayant une activité histologique ≥ 2 et/ou une fibrose ≥ 2 selon le score de Métavir et groupe non traité : ceux ayant une activité < 2 et/ou une fibrose < 2). La saisie et l’analyse des données ont été réalisées au moyen du logiciel SPSS version 20.0. Dans tous les tests statistiques, le seuil de signification était fixé à 0,05. Résultats Parmi 74 patients ayant bénéficié d’une PBF pré-thérapeutique pour une hépatite virale B, 38 patients avaient une charge virale entre 2000 et 20 000 UI/mL et un taux de transaminases normal. L’âge moyen était de 48,37 ans. Vingt-quatre patients étaient de sexe masculin. Quatre-vingt-quatre pour cent des patients étaient d’origine urbaine. Trois patients avaient la notion d’intoxication éthylique. Quinze patients avaient une surcharge pondérale. Trente patients avaient le profil sérologique d’une hépatite chronique à virus mutant pré-C. La PBF avait conclu à un score histologique ≥ A2 et/ou F2 chez 22 patients (57,9 %) et 16 patients n’étaient pas éligibles d’un traitement antiviral. L’analyse statistique avait conclu que la sévérité des lésions histologiques n’était corrélée ni à l’âge, ni au sexe, ni à l’IMC, ni au statut HBe, ni au taux des plaquettes ou d’albumine. Les lésions histologiques sévères (≥ A2 et/ou F2) étaient significativement corrélées avec un taux de TP < 70 % ( p = 0,04). Conclusion Plus que la moitié des patients ayant une hépatite chronique virale B avec un taux de transaminases normal et une virémie entre 2000 et 20 000 UI/mL avaient des lésions histologiques sévères indiquant un traitement antiviral. Ainsi, une PBF doit être considérée chez ce groupe essentiellement si le TP est < 70 %. [ABSTRACT FROM AUTHOR]

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., (© 2018 L’Encéphale, Paris.)

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., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

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., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

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., (2010. Published by Elsevier SAS.)

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.

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.

The authors report the results of an investigation of witness cases realised in collaboration between Occupational Medecine Service and Immunology Laboratory of Hedi CHAKER University Hospital SFAX during the year 2000. The purpose was to search the genetic control of the HLA class I system for the non-response to hepatitis B vaccine and to evaluate the contribution of other favorite factors as tabac, sex, age. Thus, in a population of 32 healthy agents found nonresponders to hepatitis B vaccine by the titers of anti HBs antibody, we have performed the HLA-A, -B phenotypes by the technique of complement dependent microcytotoxicity. The frequency of studied HLA class I antigens, was compared for the non-responders group, to the frequency observed in witnesses group, done with 52 responders healthy agents. The rate of nonresponsiveness hepatitis B vaccine was evaluated up to 5 %. Statistically significant difference was observed for HLA A1 and-B44 markers showing fraquencies which were considerably higher in the non-responders than in witnesses.

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.

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.

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.

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.