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Copyright of Eastern Mediterranean Health Journal is the property of World Health Organization and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In Tunisia, golf courses are irrigated with secondary treated effluent stored in landscape impoundments. The impact of the conveyance andstorage steps on the physical-chemical and biological quality of irrigation water was evaluated on three golf courses over two years. It was found that the water quality varies all along the water route, from the wastewater treatment plant up to the irrigation site: nutrientand bacteria contents decreased along the route in the three cases. This variation depends on the wastewater quality, the length of the pipes conveying water, the number of regulation reservoirs and ponds, the water residence time in pipes, reservoirs and ponds, and the operation of the ponds. The bacteriological quality of irrigation water deteriorates during the irrigation period in the three golf courses asthe ponds are operated as continuous flow reactors. The results obtained in this study indicate the inability of golf water supplies, as currently managed, to properly sanitize reclaimed wastewater and meettarget quality criteria recommended by WHO (1989) for water intendedfor recreational use. For a safe reuse of reclaimed wastewater for golf course irrigation, changes in the design and operation of the ponds should be planned or additional treatment steps provided. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate cardiorespiratory responses and intercostal muscle oxygenation during normocapnic hyperpnea exercise in chronic obstructive pulmonary disease (COPD)., Methods: Twenty-two patients with COPD performed a cardiopulmonary cycling exercise test to assess peak oxygen consumption (V˙O2peak) and minute ventilation (V˙Epeak). They also performed a normocapnic hyperpnea exercise alone, at 50%-60% of V˙Epeak to exhaustion, using a respiratory device (Spirotiger) connected to a gas analyzer to monitor V˙O2, V˙E, and end-tidal CO2 partial pressure. Cardiac output, and intercostal and vastus lateralis muscle oxygenation were continuously measured during exercise using finger photoplethysmography and near-infrared spectroscopy, respectively. Arterial blood gases (arterial PCO2) and inspiratory capacity were obtained at rest and at the end of hyperpnea exercise., Results: The hyperpnea exercise lasted 576 ± 277 s at a V˙E of 34.5 ± 12.1 L·min-1 (58% ± 6% of V˙Epeak), a respiratory rate of 22 ± 4 breaths per minute, and a tidal volume of 1.43 ± 0.43 L. From rest to the end of hyperpnea exercise, V˙O2 increased by 0.35 ± 0.16 L·min-1 (P < 0.001), whereas end-tidal CO2 partial pressure and arterial PCO2 decreased by ~2 mm Hg (P = 0.031) and ~5 mm Hg (P = 0.002, n = 13), respectively. Moreover, inspiratory capacity fell from 2.44 ± 0.84 L at rest to 1.96 ± 0.59 L (P = 0.002). During the same period, heart rate and cardiac output increased from 69 ± 12 bpm and 4.94 ± 1.15 L·min-1 at rest to 87 ± 17 bpm (P = 0.002) and 5.92 ± 1.58 L·min-1 (P = 0.007), respectively. During hyperpnea exercise, intercostal deoxyhemoglobin and total hemoglobin increased by 14.26% ± 13.72% (P = 0.001) and 8.69% ± 12.49% (P = 0.003) compared with their resting value. However, during the same period, vastus lateralis oxygenation remained stable (P > 0.05)., Conclusions: In patients with COPD, normocapnic hyperpnea exercise provided a potent cardiorespiratory physiological stimulus, including dynamic hyperinflation, and increased intercostal deoxyhemoglobin consistent with enhanced requirement for muscle O2 extraction., (Copyright © 2021 by the American College of Sports Medicine.)

Purpose: This study aimed to describe cardiorespiratory, quadriceps oxygenation, and muscle fatigue responses during a one-legged quadriceps isokinetic endurance exercise in chronic obstructive pulmonary disease (COPD) and control subjects., Methods: Fourteen patients with COPD and 14 control subjects performed a cardiopulmonary cycling exercise test to exhaustion to assess peak oxygen consumption (V˙O2peak), minute ventilation (V˙Epeak), and heart rate (HRpeak). They also performed a quadriceps isokinetic endurance exercise consisting in 30 maximal knee extensions at 90°·s with continuous monitoring of expired gases, cardiac output, and oxygenation of the quadriceps by near-infrared spectroscopy. Total muscle work and fatigue index were also quantified., Results: The total muscle work developed during the quadriceps isokinetic endurance exercise was 2.25 ± 0.57 kJ in COPD and 3.12 ± 0.60 kJ in controls, P < 0.001. In absolute terms, there were no between-group differences in V˙O2, V˙E, cardiac output, and HR at the end of quadriceps isokinetic endurance exercise. However, V˙E and HR reported that a fraction of their respective peak values during cardiopulmonary cycling exercise test were higher in COPD (V˙E/V˙Epeak, 69% ± 3%; HR/HRpeak, 82% ± 15%) compared with controls (V˙E/V˙Epeak, 45% ± 2%; HR/HRpeak, 71% ± 13%), all P < 0.05. During quadriceps isokinetic endurance exercise, quadriceps deoxyhemoglobin increased by 47% ± 31% in patients versus 33% ± 41% in controls (P < 0.05 from rest values) with a significant between-group differences (P = 0.025). The fatigue index during the quadriceps exercise was higher in COPD compared with controls., Conclusions: Although one-legged quadriceps isokinetic endurance exercise resulted in substantial central cardiorespiratory demands in COPD, this exercise was nevertheless associated with muscle overload as evidenced by muscle deoxygenation and higher muscle fatigue index in COPD compared with controls. These findings may have implications of the design of exercise training programs in COPD.

The respiratory muscle fatigue seems to be able to limit exercise performance and may influence the determination of maximal oxygen uptake (V̇O 2max ) or maximum aerobic work rate during maximal incremental test. The aim of this study was therefore to investigate whether maximal incremental exercise decreases respiratory muscle strength. We hypothesized that respiratory muscle strength (maximal pressure) will decrease after maximal incremental exercise to exhaustion. 36 runners and 23 cyclists completed a maximal incremental test on a treadmill or a cycle ergometer with continuous monitoring of expired gases. Maximal inspiratory (MIP) and expiratory (MEP) pressure measurements were taken at rest and post- exercise. At rest, the MIP and MEP were 140±25 and 172±27 in runners vs. 115±26 and 146±33 in cyclists (p<0.05 between groups, respectively). The rest values of MIP and MEP were correlated to the V̇O 2peak in all athletes, r=0.34, p<0.01 and r=0.36, p<0.01, respectively. At exhaustion, the MIP and MEP decreased significantly post- test by 13±7% and 13±5% in runners vs. 17±11% and 15±10% in cyclists (p>0.05), respectively. Our results suggest that respiratory muscle strength is decreased following maximal incremental exercise in trained runners and cyclists., (Copyright © 2017 Elsevier B.V. All rights reserved.)

We investigated the impact of ramp and constant-load exercise on (i) respiratory muscle fatigue and locomotor muscle oxygenation, (ii) their relationship with the excess VO 2 and VO 2 slow component (SC). Fourteen male cyclists performed two tests to exhaustion: an incremental ramp and a constant-load exercise with continuous monitoring of expired gases and oxygenation of the vastus lateralis muscle on two separate days. Maximal inspiratory (MIP) and expiratory (MEP) pressure measurements were taken at rest and post- exercise. The VO 2 excess represents the difference between VO 2max observed and VO 2max expected using linear equation between the VO 2 and the intensity before gas-exchange threshold. During the ramp exercise, MIP and MEP declined by 13±8 and 19±10%, respectively (p<0.05). MIP and MEP were not correlated to the excess VO 2 (0.09±0.05lmin -1 ). During the constant-load exercise, the VO 2 SC (0.70±0.22lmin -1 ) was correlated (r=0.68, p<0.01) to deoxyhemoglobin SC (2.94±1.25AU) but not to the excess VO 2 (r=0.30, p=0.2). Additionally, the significant decrease in MIP (20±9%) and MEP (23±11%) was correlated (r=0.55, p<0.05 and r=0.75, p<0.05, respectively) to the VO 2 SC. Our results show that respiratory muscle fatigue was correlated to the VO 2 SC in the constant-load exercise, whereas it was not correlated to the excess VO 2 in ramp exercise may be because of our small excess VO 2 ., (Copyright © 2017 Elsevier B.V. All rights reserved.)

We assessed respiratory muscles oxygenation responses during a ramp exercise to exhaustion and further explored their relationship with the non-linear increase of VO2 (VO2 excess) observed above the gas-exchange threshold. Ten male cyclists completed a ramp exercise to exhaustion on an electromagnetically braked cycle-ergometer with a rate of increment of 30Wmin(-1) with continuous monitoring of expired gases (breath-by-breath) and oxygenation status of intercostal muscles. Maximal inspiratory and expiratory pressure measurements were taken at rest and at exhaustion. The VO2 excess represents the difference between VO2max observed and VO2max expected using linear equation between the VO2 and the intensity before gas-exchange threshold. The deoxyhemoglobin remained unchanged until 60% of maximal aerobic power (MAP) and thereafter increased significantly by 37±18% and 40±22% at 80% and 100% of MAP, respectively. Additionally, the amplitude of deoxyhemoglobin increase between 60 and 100% of MAP positively correlated with the VO2 excess (r=0.69, p<0.05). Compared to exercise start, the oxygen tissue saturation index decreased from 80% of MAP (-4.8±3.2%, p<0.05) onwards. At exhaustion, maximal inspiratory and expiratory pressures declined by 7.8±16% and 12.6±10% (both p<0.05), respectively. In summary, our results suggest a significant contribution of respiratory muscles to the VO2 excess phenomenon., (Copyright © 2016 Elsevier B.V. All rights reserved.)

The purpose of this study was to investigate the relationships between respiratory muscle endurance, tissue oxygen saturation index dynamics of leg muscle (TSI) and the time to exhaustion (TTE) during high intensity exercise. Eleven males performed a respiratory muscle endurance test, a maximal incremental running field test (8 km h(-1)+0.5 km h(-1) each 60s) and a high-intensity constant speed field test at 90% VO2max. The TSI in vastus lateralis was monitored with near-infrared spectroscopy. The TSI remained steady between 20 and 80% of TTE. Between 80 and 100% of TTE (7.5 ± 6.1%, p<0.05), a significant drop in TSI concomitant with a minute ventilation increase (16 ± 10 l min(-1)) was observed. Moreover, the increase of ventilation was correlated to the drop in TSI (r=0.70, p<0.05). Additionally, respiratory muscle endurance was significantly correlated to TSI time plateau (20-80% TTE) (r=0.83, p<0.05) and to TTE (r=0.95, p<0.001). The results of the present study show that the tissue oxygen saturation plateau might be affected by ventilatory work and that respiratory muscle endurance could be considered as a determinant of performance during heavy exercise., (Copyright © 2016 Elsevier B.V. All rights reserved.)

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.

In Tunisia, cervical cancer incidence is about 4.8 per 100,000, but the diagnosis is often made too late, with 5-year survival rates of 35% or less. Given the budgetary constraints facing the health system, and taking into account the low incidence of cervical cancer in Tunisia, the comparative cost effectiveness analysis of screening programs must be strongly considered by policy and decision-makers. A retrospective study to estimate the average direct cost of managing cervical cancer during the first year after diagnosis was conducted among patients with cervical cancer diagnosed in 2003 at the Salah Azaiez Cancer Institute in Tunis. The study included 64 patients with cervical cancer. The direct medical cost is equal to the sum of the respective consumable costs related to hospitalization, ambulatory care, diagnostic tests, surgical procedures, chemotherapy and radiation. Regarding the in-patient hospital stay, the overall cost of a hospital day is a macro-cost including the accommodation expenses themselves, as well as staff costs and non-specific drugs. An extrapolation of the cost of care has been done at the national level; the method used consisted in multiplying the mean of the direct medical costs according to the FIGO stage by the number of incident cases at national level, for the corresponding stage. The distribution by FIGO stage was derived from the Cancer Registry of the northern region of the country. This extrapolation is an estimate, It assumes that the costs of care are similar in other health facilities, and secondly, it assumes that the distribution by FIGO stage according to that of the northern region's registrar is approximately the same at the national level. The results showed that the direct medical care cost of cervical cancer ranged from 777 to 7458 DT (431 to 4143 euro) with an average of 3180 +/- 1390 DT (1766 +/- 772 euro). The national cost was estimated at 877,680 DT (486,847 euro). Although, the cost of care for cervical cancer in Tunisia does not represent a considerable burden for health system, cervical cancer screening remains the best intervention to improve cancer survival rates.

Introduction: Radiopharmaceuticals that can bind selectively the kappa-opioid receptor may present opportunities for staging clinical brain disorders and evaluating the efficiency of new therapies related to stroke, neurodegenerative diseases or opiate addiction. The N-methylated derivative of JDTic (named MeJDTic), which has been recently described as a potent and selective antagonist of kappa-opioid receptor in vitro, was labeled with carbon-11 and evaluated for in vivo imaging the kappa-opioid receptor in mice., Methods: [(11)C]-MeJDTic was prepared by methylation of JDTic with [(11)C]-methyl triflate. The binding of [(11)C]-MeJDTic to kappa-opioid receptor was investigated ex vivo by biodistribution and competition studies using nonfasted male CD1 mice., Results: [(11)C]-MeJDTic exhibited a high and rapid distribution in peripheral organs. The uptake was maximal in lung where the kappa receptor is largely expressed. [(11)C]-MeJDTic rapidly crossed the blood-brain barrier and accumulated in the brain regions of interest (hypothalamus). The parent ligand remained the major radioactive compound in brain during the experiment. Chase studies with U50,488 (a kappa referring agonist), morphine (a mu agonist) and naltrindole (a delta antagonist) demonstrated that this uptake was the result of specific binding to the kappa-opioid receptor., Conclusion: These findings suggested that [(11)C]-MeJDTic appeared to be a promising selective "lead" radioligand for kappa-opioid receptor PET imaging.

The effects of temperature, organic modifier and the type of acid on the retention factor, the resolution and peak shape of betamethasone and dexamethasone are described. The study is performed using narrow bore porous graphitic carbon (PGC) columns online with diode-array detector (DAD) and ESI MS/MS. The results show that temperature affects the retention behaviour of the two compounds and ACN yields the best separation while no effect is obtained by changing the type of organic acid. The developed method is applied for the confirmation of dexamethasone and betamethasone in human urine.

[reaction: see text] Conjugate addition of aryl or alkyl cuprates to 3,4-dimethyl-5,6-dihydro-2(1H)-pyridinones led to diastereoisomerically pure 3,4,4-trisubstituted 2-piperidinones in 39-78% yields. The yields and the diastereochemistry of piperidinones depended on both the N-protecting group and the organocuprate. Reduction then deprotection of the trans-3,4-dimethyl-4-phenyl product provided the corresponding piperidine, analogue of a key precursor of opioid receptor antagonists.

In Tunisia, golf courses are irrigated with secondary treated effluent stored in landscape impoundments. The impact of the conveyance and storage steps on the physical-chemical and biological quality of irrigation water was evaluated on three golf courses over two years. It was found that the water quality varies all along the water route, from the wastewater treatment plant up to the irrigation site: nutrient and bacteria contents decreased along the route in the three cases. This variation depends on the wastewater quality, the length of the pipes conveying water, the number of regulation reservoirs and ponds, the water residence time in pipes, reservoirs and ponds, and the operation of the ponds. The bacteriological quality of irrigation water deteriorates during the irrigation period in the three golf courses as the ponds are operated as continuous flow reactors. The results obtained in this study indicate the inability of golf water supplies, as currently managed, to properly sanitize reclaimed wastewater and meet target quality criteria recommended by WHO (1989) for water intended for recreational use. For a safe reuse of reclaimed wastewater for golf course irrigation, changes in the design and operation of the ponds should be planned or additional treatment steps provided.

The management of hypertensive outpatients in a primary health care center raises problems of follow-up and effectiveness. This study attempts to assess the management of high blood pressure, using the Medical Audit method, essentially. For that purpose, 194 medical records of hypertensive outpatients registered between 1980 and 1986 were studied. More than 80% of these patients were women between the ages of 40 and 70 years. The medical records of these patients were compared to a standard management scale including 68 items devised by cardiologists and general practitioners. Globally, 32% of the items were cardiologists and general practitioners. Globally, 32% of the items were respected during management of the outpatients. The initial check-up was the least followed item (6.9%), but afterwards care of patients improved, giving ratings of: 29% for respect of treatment protocol, and 35% for surveillance of treatment. As concerns treatment effectiveness, only 28% of the patients (n = 36) actually completed the five-year follow-up period. In these patients average blood pressure fell from 193 to 143 mmHg (systolic), and from 113 to 93 mmHg (diastolic), between the beginning of monitoring and the end of the fifth year. The insufficiency of high blood pressure management results not only from a shortage of resources, but also from underuse of existing ones, and the practitioners' lack of information.