VITAMIN D STATUS IN A HEALTHY TUNISIAN POPULATION

Vitamin D deficiency is one of the most common medical conditions worldwide. In Tunisia, several studies evaluated Vitamin D status, but this was concerning specific populations (pregnant women, obese or diabetic patients and children with asthma). The only study that evaluated Vitamin D status in a healthy Tunisian population was conducted by Meddeb and al. in 2002. The update of data available, based on the currently recommended limits, is necessary. This study aimed to estimate the prevalence of hypovitaminosis D in a healthy Tunisian population, and correlate the values with potential risk factors. It was conducted on 209 Tunisian healthy subjects. Data collected included clinical characteristics and dietary intakes. We measured 25-hydroxyvitamin D (25(OH)D), parathyroid hormone (PTH), glycemia, creatinine, calcium, phosphorus, proteins and alkaline phosphatase levels. Hypovitaminosis D was retained for 25(OH)D concentrations <30ng/ml. Vitamin D deficiency was defined by 25(OH)D concentrations <10 ng/ml. The prevalence of hypovitaminosis D and vitamin D deficiency were respectively 92.3% and 47.6%. The main factors that were significantly associated with low vitamin D levels in our multivariate analysis were veiling, living in rural areas and sunscreen use. However, sex, age, socioeconomic level, phototype, solar exposure score, smoking and bone mass index, were not statistically associated with hypovitaminosis D. The study of relationship between vitamin D status and serum PTH levels showed a significative and negative correlation (p< 0.005). Given the high prevalence of vitamin D, an adapted health policy is essential. A widespread vitamin D supplementation and food fortification seems to be necessary in Tunisia.

Body and Sartorial Paradox in Physical Education: A New Look at the Gender Interaction and Co-Educational System in Physical Education Class

Since the Tunisian Revolution of 2010, two views (modernism and conservatism) conduct two opposite social projects for the Tunisian population, which affect, in first order, the school from primary to secondary level. The Tunisian educational system is based on co-education, contradicting the country&rsquo;s conservatism culture. The religious dress (veil/hijab) is accepted and tolerated in schools. Physical education, as an educational discipline, had to adapt to these changes, especially to the religion dress and gender interaction. The aim of this paper is to study, through the representations of physical education&rsquo;s (PE) teachers, the paradoxes observed between physical practice and religious dress (veil/Hijab) and the management of the co-educational system in PE classes. This is based on the opinion which indicates that this matter requires the student&rsquo;s body and physical ability to be independent from their gender, dress or motor skills. The results show a difference in opinion between females and male teachers regarding gender interaction and religious dress.

30 day predicted outcome in undifferentiated chest pain: multicenter validation of the HEART score in Tunisian population

Background Chest pain remains one of the most challenging serious complaints in the emergency department (ED). A prompt and accurate risk stratification tool for chest pain patients is paramount to help physcian effectively progrnosticate outcomes. HEART score is considered one of the best scores for chest pain risk stratification. However, most validation studies of HEART score were not performed in populations different from those included in the original one. Objective To validate HEART score as a prognostication tool, among Tunisian ED patients with undifferentiated chest pain. Methods Our prospective, multicenter study enrolled adult patients presenting with chest pain at chest pain units. Patients over 30 years of age with a primary complaint of chest pain were enrolled. HEART score was calculated for every patient. The primary outcome was major cardiovascular events (MACE) occurrence, including all-cause mortality, non-fatal myocardial infarction (MI), and coronary revascularisation over 30 days following the ED visit. The discriminative power of HEART score was evaluated by the area under the ROC curve. A calibration analysis of the HEART score in this population was performed using Hosmer–Lemeshow goodness of test. Results We enrolled 3880 patients (age 56.3; 59.5% males). The application of HEART score showed that most patients were in intermediate risk category (55.3%). Within 30 days of ED visit, MACE were reported in 628 (16.2%) patients, with an incidence of 1.2% in the low risk group, 10.8% in the intermediate risk group and 62.4% in the high risk group. The area under receiver operating characteristic curve was 0.87 (95% CI 0.85–0.88). HEART score was not well calibrated (χ2 statistic = 12.34; p = 0.03). Conclusion HEART score showed a good discrimination performance in predicting MACE occurrence at 30 days for Tunisian patients with undifferentiated acute chest pain. Heart score was not well calibrated in our population.

Skin Autofluorescence Profile in Tunisian Subjects with and Without Metabolic Disorders

Background: The AGE Reader, as a clinical tool for non invasive assessment, measures the accumulation of advanced glycation end products (AGEs) in skin tissues shown as skin autofluorescence (SAF). AGEs Accumulation has been implicated in several diseases. There is no data about SAF profile in Tunisian population, this study aimed to assess firstly SAF profile in subjects with and without metabolic disorders and secondly to examine the association between SAF and various clinical parameters.Methods: In a cross-sectional study, we included 220 participants between 19 and 86 years of age who were subdivided in two groups: a healthy group (n=93) and patients group with metabolic disorders (n=127) contains three subgroups as following: diabetic patients (n=32), hypertensive patients (n=54) and patients with both diabetes and hypertension (n=41). Skin AGEs accumulation was measured by AGE Reader and clinical data was obtained.Results: SAF was significantly higher in patients group compared to healthy group [2.40 AU (2.10-2.60) vs. 2.00 AU (1.70-2.10) respectively; P <0.001]. Diabetic patients and hypertensive patients showed an increased level of SAF. The highest of SAF was observed in patient with both coexistence of diabetes, hypertension and dyslipidemia. SAF was associated with age, gender, BMI, duration of diabetes, HbA1c, triglyceride and obesity. Multivariate analysis showed that age and duration of diabetes were independent determinant of SAF. The ROC analysis indicated that an SAF > 2.25 AU was optimal cut-off point to predict the presence of metabolic disorders (P <0.001). Conclusion: SAF was increased in patients with diabetes and/or with hypertension and dyslipidemia. AGE Reader device is a rapid and helpful tool in clinical practice for evaluating and screening metabolic disorders in undiagnosed subjects.

Mitochondrial DNA and Alzheimer's Disease: A First Case-control Study of the Tunisian Population

Background: Alzheimer’s disease (AD) is the most common neurodegenerative disorder in humans and presents a major health problem throughout the world. The etiology of AD is complex, and many factors are implicated, including mitochondria. Mitochondrial alteration has been proposed as a possible cause of AD Therefore, several studies have focused on finding an association between inherited mitochondrial DNA variants and AD onset.Methods: In this study, we looked, for the first time, for a potential association between mitochondrial haplogroups or polymorphisms and AD in the Tunisian population. We also evaluated the distribution of the major genetic risk factor for AD, the apolipoprotein E epsilon 4 (APOE ε4), in this population. In total, 159 single-nucleotide polymorphisms (SNPs) of mitochondrial DNA haplogroups were genotyped in 254 individuals (58 patients and 196 controls). An additional genotyping of APOE ε4 was performed.Results: No significant association between mitochondrial haplogroups and AD was found. However, two individual SNPs, A5656G (p = 0.03821, OR = 10.46) and A13759G (p = 0.03719, OR = 10.78), showed a significant association with AD. APOE 4 was confirmed as a risk factor for AD (p = 0.000014). Conclusion: Our findings may confirm the absence of a relation between mitochondrial haplogroups and AD and support the possible involvement of some inherited variants in the pathogenicity of AD.