Basal cell carcinoma (BCC) is the most frequent skin cancer but <1% of the cases develop in the vulva. Histoprognostic features of vulvar BCCs are not recognized and, consequently, the treatment of the disease is not well codified. To overcome this lack of knowledge, we have performed a retrospective analysis of vulvar BBCs to assess the value of various histological features regarding the disease outcome. In all, 19 patients surgically treated for a vulvar BCC in the Centre Hospitalier Intercommunal de Créteil from March 1, 2000 to September 26, 2019 were retrieved. Clinical and histologic features were reviewed in all cases and analyzed in comparison with disease recurrence and patient's survival. The median age of the patients was 74 (range 54-99) yr. Tumor location on the labium majus was the most frequent (68%). None presented with a medical condition related to BCC. All the patients were treated by surgery alone, except one who benefited from additional radiotherapy. We found a significant association between tumor size and recurrences (P = 0.031). Other features associated with disease outcome were tumor thickness, treatment type, and surgical margins. Recurrence was observed for tumors larger than 20 mm with a surgical margin of less than 3 mm. A combination of tumor size, thickness, and surgical margin are histoprognostic factors more significant than tumor subtype.
Background Mortality data represent a primary source of information for monitoring a population health status over years. In Tunisia, the national Information System on Causes of Death (ISCD) lacks completeness (average coverage rate of 40%); however, in order to examine covid-19’s effect on mortality data, the ISCD was reinforced. We aimed to give an overview of leading causes of death in Tunisia for 2020. Methods Data were obtained from Medical Certificates of Cause Of Death (MCCOD) sent by municipalities to the National Institute of Health in accordance with the legislative framework. Causes of Death (CoD) coding process was performed based on the International Classification of Diseases, Tenth Revision (ICD-10). The underlying cause of death was identified based on IRIS software, and mortality statistics were presented based on the world health organization cause-of-death lists for tabulating mortality statistics. Data analysis was performed using SPSS software. Results A total of 46.420 MCCOD among 75.365 deaths officially declared by the National Institute of Statistics, were analyzed (coverage rate of 61.2%). The 10 leading causes of death for both sexes, in rank order were: diabetes mellitus, cerebrovascular diseases, covid-19, ischemic heart diseases, external causes of death, digestive and pulmonary malignant neoplasms, conditions of neonatal period, hypertensive diseases, and influenza and pneumonia. Leading causes of infant deaths were: certain conditions originating in perinatal period, congenital malformations, deformations and chromosomal abnormalities, diseases of respiratory system, certain infectious and parasitic diseases, and diseases of nervous system. Conclusions The COVID-19 pandemic was an opportunity to improve the Tunisian ISCD’s coverage rate. However, efforts should be maintained to optimize system completeness, and decision makers should be more sensitized regarding the urgent need for system digitalization. Key messages • Mortality statistics have shown that covid-19 ranks third among leading causes of death in Tunisia for 2020; and non communicable disease accounted for 6 out of 10 leading causes of deaths. • The ISCD coverage rate was improved in 2020 reaching 61.2%; however the system digitalization is an essential and sustainable solution to optimize completeness.
Background Cannabis is the most widely used illicit psychoactive substance worldwide. In Tunisia, the prevalence of cannabis use and its association with other risky behaviours were reported in several publications interesting mainly early adolescence. However, no publications exploring trends based on national epidemiological data are available yet. Our purpose was to determine cannabis prevalence in Tunisian high school adolescents and assess significant trends from 2013 to 2021. Methods Pooled data from Mediterranean school surveys on alcohol and other drugs conducted in 2013, 2017, and 2021, were used. Based on three-stage stratification sampling method, first and second grade secondary education students were enrolled. Were not included students enrolled in vocational training centers and out-of-school adolescents. Self-administered standardized questionnaire was used in data collection. We studied weighted lifetime prevalence of cannabis use and chi square test for trend was used for global, by gender and by sector (private/public) trends assessement. STATA software was used for statistical analysis. Results A total of 14.723 students were enrolled with sex ratio (M/F) equal to 0.61 and mean age of 16.2±0.8 years. The prevalence of cannabis use increased from 1.4%, to 3.8% then to 7.9% for 2013, 2017 and 2021 respectively. Trend assessement concludes to significant increase in overall cannabis use (p < 10-3). Besides, there was a significant increase in both public and private schools, and among both boys and girls. However, the greatest increase was among male students (3.5% in 2013, 9.2% in 2017 and 16.1% in 2021) (p < 10-3). Conclusions Despite the reinforcement of restrictive legislative measures, the prevalence of cannabis use among Tunisian high school adolescents is significantly increasing. Moreover, it’s important to further investigate problematic cannabis use and its effects on adolescents’ physical and mental health. Key messages • Trend assessement confirmed the significant increase in lifetime cannabis use in high school adolescents in Tunisia, for both sexes and for both private and public sector. • This alarming public health issue requires urgent legislation review and close multisectoral collaboration to control supply and demand.
Background Tobacco use is a global health concern, with smoking initiation often beginning in adolescence. In Tunisia, published data assessing trends of tobacco consumption at the national level only concerns middle school students aged 13 to 15 years. No data related to high school students are however published yet. We aimed to determine tobacco smoking prevalence in Tunisian adolescents and assess trends from 2013 to 2021. Methods Pooled data from three Mediterranean school surveyson alcohol and other drugs (MedSPAD surveys: 2013, 2017, and 2021) were used. Based on three-stage stratification sampling method, teenagers aged between 15 and 17 years, were enrolled. Were not included students enrolled in vocational training centers and out-of-school adolescents. Data collection was performed using a self-administered standardized questionnaire assessing socio-demographic characteristics and risky behaviours. We studied weighted prevalence estimates of cigarettes and water pipe (WP) smoking. All statistical analysis, including trend analysis, were performed with STATA software. Results A total of 14.723 students were enrolled with sex ratio (M/F) equal to 0.6 and mean age of 16.2±0.8 years. The prevalence of cigarette smoking increased from 17.8%, to 20.2% then to 24.7% for 2013, 2017 and 2021, respectively. As for WP smoking, its prevalence increased from 14.8%, to 16.7% then to 19.9% for 2013, 2017 and 2021, respectively. Trends analysis concluded to significant increase over study period for cigarettes and WP smoking (p < 10-3). The increase was most alarming for girls regarding WP smoking (consistent increase over the study period). Conclusions Our findings underscore the alarming increasing trend for different forms of tobacco smoking among Tunisian youth. It is therefore crucial to strengthen tobacco control measures among young adolescents in order to counteract the tobacco industry’s expanding marketing of new products primarily targeting this population. Key messages • The prevalence of cigarette and water pipe smoking increased significantly among high school Tunisian adolescents from 2013 to 2021. • A better commitment to the implementation of MPOWER measures for tobacco control is therefore urgent.
Background Nonmedical use of prescription drugs such as sedatives and anxiolytics is a fast growing public health threat in several countries. In Tunisia, although several studies have investigated the prevalence of nonmedical use of anxiolytics among school-age students, there is a gap in knowledge regarding trends in anxiolytics misuse. We aimed to determine the prevalence of nonmedical use of anxiolytics and examine trends between 2013 and 2021. Methods Pooled data from three Mediterranean school surveys on alcohol and other drugs (MedSPAD I-2013, MedSPAD II-2017, MedSPAD III-2021) were used. Based on three-stage stratification sampling method, teenagers in first and second grades of secondary education, were enrolled. Were not included students enrolled in vocational training centers and out-of-school adolescents. Data collection was performed using a self-administered standardized questionnaire. We studied weighted lifetime nonmedical use of prescription anxiolytics and performed global and by gender trend analysis. Epi data software was used for data entry and all statistical analysis, were performed with STATA software. Results A total of 14.723 students were enrolled with sex ratio (Male/Female) equal to 0.61 and mean age of 16.2±0.8 years. The prevalence of nonmedical anxiolytics’ use increased from 2.1% to 3% then to 8.4% for 2013, 2017 and 2021, respectively. Global and by gender trends analysis concluded to significant increase from 2017 to 2021 (p < 10-3). However, a non-significant increase was revealed from 2013 to 2017. Conclusions Our study is the first to confirm a significant increasing trend in non-medical use of anxiolytics among Tunisian adolescents. These findings emphasize the urgent need for early detection of psychological vulnerability among adolescents in order to prevent their engagement in such risky behaviors. Key messages • Decision makers should be sensitized regarding the alarming increasing trend in non-medical use of anxiolytics, among Tunisian adolescents. • The state control of these substances accessibility and early detection of psychological vulnerability, are highly required.
Background Diabetes, a major public health issue in Tunisia, is responsible of an increased burden of morbidity and premature mortality. Achieving a good glycemic control is essential for reducing the morbidity-mortality associated with this disease. The purpose of our study was to assess the proportion of uncontrolled diabetes (UD) among Tunisian diabetic adults and assess associated factors. Methods A national household survey, stratified at three degrees, was conducted in 2016. As part of this study, we included previously diagnosed diabetic adults aged 20 years or above. Sociodemographic data and medical history were collected using an individual questionnaire, and glycated hemoglobin (HbA1C) was measured using the “A1C Now +” device. The UD was defined based on the American Diabetes Association criteria for the year 2016 (HbA1c ≥7%). Multiple logistic regression model was used to determine factors associated with UD. Adjusted Odds Ratios (AOR) were presented with 95% confidence intervals (CI). All data analysis was performed using SPSS software. Results A total of 873 subjects were included with a median age of 61 years and a sex-ratio equal to 0.9. The proportion of UD was (72.8%, 95% CI: [69.1-76.3]). In multivariate analysis, UD was more frequent among rural areas residents (AOR=1.8 [1.1-2.7]), those who had never seen a doctor within the year preceding the survey (AOR=2.2 [1.1-4.2]) and among those on oral antidiabetics (AOR=6.1 [1.9-18.9]) or insulin (AOR=23.8 [7.1-79.8]) compared to those who were following a diabetic diet. Conclusions This study highlighted a very high proportion of UD in diabetic Tunisian adults. A better involvement of primary care physicians in overall patient care, and improved availability of antidiabetic drugs for patients, are strongly recommended. Key messages Majority of Tunisian diabetic adults aged 20 years or older had an uncontrolled diabetes. Improving patient education and the availability of antidiabetic drugs for diabetic individuals in primary healthcare facilities is essential.
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