Une colite à CMV révélant un lupus érythémateux systémique

Le cytomégalovirus (CMV) est responsable d’infections souvent asymptomatiques chez les immunocompétents mais également d’infections graves chez les immunodéprimés notamment chez les patients lupiques. La réactivation du CMV au cours du lupus est une complication fréquente mais rarement inaugurale. Nous rapportons l’observation d’un patient ayant présenté une colite à CMV révélatrice d’un lupus érythémateux systémique. Le diagnostic a été retenu sur les données sérologiques, de la biopsie colique et la bonne évolution après un traitement par ganciclovir

Les paroxysmes climato-thermiques en Tunisie : approche méthodologique et étude de cas

Le climat de la Tunisie, caractérisé par une grande variabilité, est souvent exposé à des extrêmes climato-thermiques, parfois aigus, qui méritent le qualificatif de paroxysme. Ces événements extrêmes se manifestent soit par des anomalies thermiques positives très amples, traduisant une chaleur intense, soit par des anomalies négatives, synonymes de paroxysmes de froid. Toutefois, la définition de ces paroxysmes, loin d’être unanime, est objet à controverses. Dans le présent travail, nous proposons une double méthodologie pour déterminer les critères et seuils de ces paroxysmes, adaptée au contexte tunisien. Deux types d’indices de chaleur et de froid sont proposés : relatifs et absolus. Pour valider cette méthodologie, nous avons comme exemple les séries des températures maximales et minimales quotidiennes observées à Tunis-Carthage entre 1950 et 2006

Apports pluviométriques et types de flux de surface en Tunisie du Nord

La Tunisie du Nord représente la région la mieux arrosée du pays, et elle est de ce fait une importante région agricole. L’information climatique, fiable à des échelles réduites, ne peut être que d’un grand intérêt dans des domaines aussi dépendants du climat que les ressources en eau et l’agriculture. Dans cette étude, nous nous intéressons à un élément du climat, en l’occurrence la pluie, dans sa variation spatio-temporelle à des échelles fines. Nous étudions les apports quotidiens en fonct..

Fortes chaleurs et circulation atmosphérique associée autour de la Méditerranée orientale : cas du littoral tunisien et syro-libanais

The eastern Mediterranean is is characterized by temperature contrasts between the east and west shores. In particular, comparative analysis of high temperatures between the Tunisian east coast and the Levantine one shows a higher exposure of the latter in terms of frequency and intensity. The regional atmospheric circulation and local factors, especially those of relief, justify these contrasts

2-Day versus C-reactive protein guided antibiotherapy with levofloxacin in acute COPD exacerbation: A randomized controlled trial.

IntroductionDuration of antibiotic treatment in acute exacerbation of COPD (AECOPD) is most commonly based on expert opinion. Biomarker guided strategy is increasingly recommended to limit unnecessary antibiotic use. We performed a randomized controlled study to evaluate the efficacy of 2-day versus C-reactive protein (CRP)-guided treatment with levofloxacin in patients with AECOPD.MethodsPatients with AECOPD were randomized to receive oral levofloxacin daily for 7 days unless the serum CRP level decreased by at least 50% from the baseline value or levofloxacin for two days; thereafter, oral placebo tablet was prescribed according to the CRP. The primary outcome measure was cure rate, and secondary outcome included need for additional antibiotics, intensive care unit (ICU) admission, exacerbation rates and exacerbation free interval (EFI) within one-year follow-up.ResultsIn intention to treat (ITT) analysis, cure rate was 76.1% (n = 118) and 79.3% (n = 123) respectively in 2-day and CRP-guided groups. In per protocol (PP) analysis, cure rate was 73% (n = 92) and 70.4% (n = 88) respectively in 2-day and CRP-guided groups. The difference between the two groups was not significant. The need for additional antibiotics and ICU admission rates were not significantly different between the two groups. One-year exacerbation rate was 27% (n = 42) in 2-day group versus 30.3% (n = 47) in CRP-guided group (p = 0.53); the EFI was 125 days (interquartile range, 100-151) versus 100 days (interquartile range, 78-123) in 2-day and CRP-guided groups respectively (p = 0.45). No difference in adverse effects was detected.ConclusionLevofloxacin once daily for 2 days had similar efficacy compared to CRP-guided in AECOPD. This short course treatment decreased antibiotic consumption which would improve patient compliance and reduce adverse effects

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

Abstract 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

Two-day seven-day course of levofloxacin in acute COPD exacerbation: a randomized controlled trial

Introduction: Duration of antibiotic treatment in acute exacerbation of COPD (AECOPD) is most commonly based on expert opinion. Typical administration periods range from 5 to 7 days. A 2-day course with levofloxacin was not previously assessed. We performed a randomized clinical trial to evaluate the efficacy of 2-day versus 7-day treatment with levofloxacin in patients with AECOPD. Methods and analysis: Patients with AECOPD were randomized to receive levofloxacin for 2 days and 5 days placebo ( n  = 155) or levofloxacin for 7 days ( n  = 155). All patients received a common dose of intravenous prednisone daily for 5 days. The primary outcome measure was cure rate, and secondary outcomes included need for additional antibiotics, ICU admission rate, re-exacerbation rate, death rate, and exacerbation-free interval (EFI) within 1-year follow-up. The study protocol has been prepared in accordance with the revised Helsinki Declaration for Biomedical Research Involving Human Subjects and Guidelines for Good Clinical Practice. The study was approved by ethics committees of all participating centers prior to implementation (Monastir and Sousse Universities). Results: 310 patients were randomized to receive 2-day course of levofloxacin ( n  = 155) or 7-day course ( n  = 155). Cure rate was 79.3% ( n  = 123) and 74.2% ( n  = 115), respectively, in 2-day and 7-day groups [OR 1.3; 95% CI 0.78–2.2 ( p  = 0.28)]. Need for additional antibiotics rate was 3.2% and 1.9% in the 2-day group and 7-day group, respectively; ( p  = 0.43). ICU admission rate was not significantly different between both groups. One-year re-exacerbation rate was 34.8% ( n  = 54) in 2-day group versus 29% ( n  = 45) in 7-day group ( p  = 0.19); the EFI was 121 days (interquartile range, 99–149) versus 110 days (interquartile range, 89–132) in 2-day and 7-day treatment groups, respectively; ( p  = 0.73). One-year death rate was not significantly different between the 2 groups, 5.2% versus 7.1% in the 2-day group and 7-day group, respectively; ( p  = 0.26). No difference in adverse effects was detected. Conclusion: Levofloxacin once daily for 2 days is not inferior to 7 days with respect to cure rate, need for additional antibiotics and hospital readmission in AECOPD. Our findings would improve patient compliance and reduce the incidence of bacterial resistance and adverse effects

Short- and long-term outcomes of kidney donors: A report from Tunisia

Kidney transplantation remains the best treatment option of end-stage renal disease. Kidney donations are of particular interest with the currently increasing practice of living-donor transplantation. The purpose of this study was to analyze retrospectively the general health status as well as renal and cardiovascular consequences of living-related kidney donation. A total of 549 living-related kidney donors had donated their kidneys between 1986 and 2007. We attempted to contact all donors to determine short- and long-term outcome following kidney donation. All kidney donors who responded underwent detailed clinical and biochemical evaluation. The data were compared with age-matched health tables of the Tunisian general population. In all, 284 donors (52%) had a complete evaluation. They included 117 men and 167 women with a mean age of 42 ± 12 years. The major peri-operative complications that occurred in these donors included four cases of pneumothorax, six cases of surgical site infection, one case of phlebitis and one case of pulmonary embolism. None of the study cases died. The median length of hospital stay after donor nephrectomy was 6.5 days (range: 3-28 days). The median follow-up period was eight years. The mean creatinine clearance after donation was 90.4 ± 25 mL/min in men and 81.5 ± 27.2 mL/min in women. Proteinuria was >300 mg/24 h in 17 cases (5.9%). Fifty-eight (20.4%) donors became hypertensive and 19.6% of the men and 37.2% of the women became obese. Diabetes mellitus developed in 24 (8.4%), and was more common in patients who had significant weight gain. Our study suggests that kidney donors have minimal adverse effects on overall health status. Regular follow-up identifies at-risk populations and potentially modifiable factors. Creation of a national registry of living donors and their monitoring are an absolute necessity

Eau et environnement

Cet ouvrage est le fruit d’une collaboration entre climatologues, hydrologues et biogéographes tunisiens et français, entretenant un dialogue d’une rive à l’autre de la Méditerranée. Son contenu privilégie le quantitatif, le chiffre, plus que le rêve cher à Bachelard. Les volumes d’eau en mètres cube, par dizaines ou par milliards, et les hauteurs d’eau, en millimètres ou en mètres, y sont plus présents que le rare, le précieux, le beau et le poétique. Eau et environnement met délibérément l’accent sur les anomalies plus que sur les régularités. Le trop pluvieux, le trop sec, le trop mal réparti, le trop érosif, le trop mal exploité, le trop mal utilisé… y sont déclinés à diverses échelles, du pays au bassin versant élémentaire, en passant par les régions où se révèlent les déséquilibres de la ressource et de son utilisation. Eau et environnement s’inscrit dans un temps précis, la fin du xxe siècle, et brosse un état des lieux propre à la Tunisie et à la France, avec une courte référence à l’Algérie. L’ambition de la communauté de chercheurs qui ont contribué à cet ouvrage est néanmoins d’élargir les visions sectorielles des questions de l’eau à des approches dites intégrées, globales ou systémiques, susceptibles de se décliner sur d’autres espaces. Flotte cet esquif au fil du grand courant des études dédiées à l’eau !This volume is the result of a collaboration between Tunisian and French climatologists, hydrologists and biogeographers who have engaged in a dialogue from one shore of the Mediterranean to the other. In terms of content it concentrates on quantitative data and figures rather than Bachelard’s cherished dream. Water volumes expressed in tens or thousands of cubic metres, and water levels, in millimetres or metres, feature more prominently than rare, precious, beautiful or poetic details. Eau et environnement deliberately focuses on anomalies more than regularities. Excessive rainfall, insufficient rainfall, where water is too unevenly distributed, where it is too erosive, where it is under exploited or where it is too inefficiently used... all this information is provided at different levels, from the country to the basic catchment area, including regions where imbalances in the supply and use of the resource are identified. Eau et environnement focuses on a specific period in time, the end of the 20th century, and presents the specific situation in Tunisia and France, along with a short reference to Algeria. The ambition of the community of researchers who contributed to this volume is, however, to widen perceptions within the sector on water-related issues to include so-called integrated, global or systemic approaches which might be rolled out in other areas. This vessel will certainly be carried along in the current of water-related research