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This research examines demographics, socioeconomic, eating habits, andphysical activity on obesity prevalence in students of Libya. The present study population consists of undergraduate students joining the universities of the west coast of Libya. Specifically, the research has been carried out with undergraduate students of two public universities (Zawia University and Sabaratha University) of Libya. The present study has used a survey based on the constructs of the conceptual framework. Therefore, self-distributed questionnaires for each of 500 samples of the student to collect from the questionnaire.This research has done a comprehensive theoretical discussion to be able to come up with the research hypotheses. The hypotheses were that there is a significant relationship between demographic factors and obesity prevalence in undergraduate students of Libya. Also, there is no significant relationship between socioeconomic factors and obesity prevalence in undergraduate students of Libya and.Furthermore, there is a significant difference between male and female undergraduate students in terms of eating habits. And finally, there is a significant difference between male and female undergraduate students in physical activity.Moreover, the study proposes the management take the initiative for the implementation of strategies that will be helpful to get the awareness about obesity among students in Libya.

BackgroundJuvenile Idiopathic Arthritis (JIA) has an impact on the quality of life of the patient and his family. Parent/patient reported outcomes have shown an increasing interest in the management of JIA because it reflects the perception of the disease course and the effectiveness of the therapeutic interventions.ObjectivesTo determine the level of agreement between patients with JIA and their parents for the five quantitative items in Juvenile Arthritis Multidimensional Assessment Report (JAMAR) questionnaire.MethodsWe included children aged between 7 and 18 years old with AJI (ILAR criteria) and their parents. Demographic data and disease related parameters were collected. We asked both parent and child to complete the five quantitative items of JAMAR questionnaire. Were measured on a 21-numbered circle visual analogue scale (VAS) for pain (0 =no pain; 10 =very severe pain), disease activity (DA): (0 =no activity; 10 =maximum activity) and well-being (WB): (0 =very well; 10 =very poorly). Physical function was assessed by Juvenile Arthritis Functional Score (JAFS) [0-45] and health-related quality of life (HRQoL) [0-30] through the Physical Health (PhH) and Psychosocial Health (PsH) subscales. We calculated children and parents median scores for the five items. Intra class correlation coefficient ICC was used for analysis (ICC below 0.50: poor; between 0.50 and 0.75: moderate; between 0.75 and 0.90: good; above 0.90: excellent).ResultsA total of 21 patients/parent (12 girls and 9 boys) were included in the study. Forty percent belong to rural enviroment. Majority of patients were in secondary school (77%), 23% were in primary school. Seven patients had oligoarticular JIA, 13 had polyarticular JIA and one had systemic JIA. Median age at diagnosis was 11.4 ± 1.2 years [6-13]. Median age at disease onset was 9.5 ± 1.9 years [2-13]. Median disease duration was 4.3 years [0-7]. Median JADAS was 10 [8-18]. Uveitis was noted in 30% of cases. Comparison of parent proxy-reported and child self-reported data revealed a striking similarity for all items (pTable 1.Assessement of quantitative items of Juvenile Arthritis Multidimensional Assessment Report by patients and parents.ItemsPatientsParentsICCMean pain VAS (0-10)4.2 [4-6]4.3[4-6]0.97Mean disease activity VAS (0-10)4.1 [4-5]4.2 [4-5]0.81Mean well-being VAS (0-10)4.4 [4-6]4.3 [4-5]0.9Mean Juvenile Arthritis Functional Score (JAFS)10.0 [1-20]10.2 [2-21]0.81Mean HRQoL score14.1 [7-17]14.8 [6-14]0.88ICC: Intraclass Correlation Coefficient; HRQoL: Health-Related Quality of Life; VAS: Visual Analogue Scale.ConclusionOur study showed high level of agreement between patients and parents. The JAMAR provides a promising approach to quantitative measurement in standard pediatric rheumatology care. Availability of this new instrument may enhance regular use of parent/patient questionnaires in routine practice and improve disease management.Disclosure of InterestsNone declared

Introduction: Thoracic involvement during rheumatoid arthritis (RA) often requires several investigations including thoracic CT scans which had greatly improved the approach to the rheumatoid lung. Aim of study: assess thoracic involvement in RA using a radiological score. Method: A two-year retrospective study including the records of patients followed for RA with pleuro-pulmonary involvement. All patients had a high-resolution thoracic CT scan. Diffuse interstitial lung disease was assessed by the Warrick score composed of two parts: disease severity score (quotation of 5 types of elementary lesions) and disease extend score (number of segments involved). Results: 24 records were enrolled (Average age=59years; sex-ratio F/H=1.66). The diagnosis of RA was done in average since 8 years. Seventeen patients received Methotrexate®, 6 Salazopyrine®, 2 Palquenil® and 1 Imurel®. In thoracic CT scan there were nodules in 29% of cases, bronchiectasis in 25%, ground-glass opacities in 42%, septal and subpleural lines in 42%, honeycombing in 12%, constrictive bronchiolitis in 8% and emphysema in 17%. The average FVC was 2.48l/min(72%), FEV1 was 1.78l/min(70%) and TPC was 4.14l/min(81%). The average of severity score was 6.4, its of disease extend 8.3 and the Warrick score was 14.7. The disease severity score was higher in the patient receiving Imurel®(10 vs 6;p=0.068) and Salazopyrine®(8 vs 5; p=0.015). FVC was inversely correlated to ground-glass opacities in CT scan (60% vs 76%;p=0.022), to honeycombing (53% vs 74%;p=0.048) and to septal and subpleural lines (62% vs 79%;p=0.022). Conclusion: The Warrick score is a good tool for predicting the severity of RA which will require second line treatment

The aim of the present study is to compare the clinical features, disease activity, and physical impairment between non-radiographic axial spondyloarthritis and ankylosing spondylitis in Tunisian patients.This is a retrospective study conducted in a single rheumatology center in Tunisia. Patients with axial spondyloarthritis fulfilling the 2009 ASAS criteria were included. The various spondyloarthritis-related variables were compared between non-radiographic axial spondyloarthritis and ankylosing spondylitis. p Values below 0.05 were considered statistically significant.Among 200 patients with axial spondyloarthritis, 40 had non-radiographic axial spondyloarthritis and 160 had ankylosing spondylitis. The non-radiographic axial spondyloarthritis patients were more frequently female, were younger, and had shorter disease duration. Patients with non-radiographic axial spondyloarthritis experienced enthesitis more frequently compared with ankylosing spondylitis patients. Psoriasis was more frequent in non-radiographic axial spondyloarthritis group, while inflammatory bowel disease was more frequent in ankylosing spondylitis group. The C-reactive protein level and functional score were significantly higher in patients with ankylosing spondylitis compared with non-radiographic axial spondyloarthritis. Tumor necrosis factor inhibitors were offered significantly more often to the ankylosing spondylitis group. There was no statistically significant difference between the 2 groups in other spondyloarthritis parameters.The non-radiographic axial spondyloarthritis is characterized mainly by a marked female prevalence, a higher enthesitis prevalence, and a better physical function.• Patients with nr-axSpA in Tunisia are more frequently female and have shorter disease duration compared with those with AS. • Peripheral manifestations were similar between nr-axSpA and AS patients except for enthesitis which were more frequent within nr-axSpA patients. • The disease activity is similar between the 2 groups of axSpA but the physical function is better within nr-axSpA patients.

Smoking cessation should be a priority for smokers, especially coronary patients.To study the place and effectiveness of acupuncture in smoking cessation in coronary patients.We conducted a prospective open-label study of 25 coronary smokers treated by acupuncture over a 10-month period, from June 2017 to March 2018. A 2-session protocol acupuncture weekly for three to five weeks, with a positive response. In order to evaluate the effectiveness of acupuncture, a questionnaire was completed by the doctor during the treatment, at three and six months after the end of the sessions. Positive response was defined by total cessation of smoking.The average age of our patients was 55.5 years (33 to 77 years). The sex ratio of our population was 1.5 with a male predominance. All our patients had a coronary history. The average cigarette consumption was 22.7 pack-years on average. The results of our study showed that acupuncture allows the withdrawal of 5 smokers (20%) from the first session. After the fifth session, 60% of our patients stopped smoking. At the end of the treatment, 17 smokers (70%) stopped smoking completely. At 3 and 6 months of treatment, we observed a stabilization of smoking cessation and decrease rates.Smoking cessation is difficult to obtain whatever the therapeutic method used, which encourages us to strengthen preventive measures.

Introduction La TDM thoracique à haute résolution est considérée comme un outil de dépistage et de diagnostic précoce dans la pneumopathie à COVID-19. Elle peut mettre en évidence des anomalies même au cours des premiers jours d’infection. Le but de cette étude est d’évaluer les anomalies pulmonaires sur la TDM thoracique chez les patients atteints de pneumopathie à COVID-19 et les corréler à la durée des symptômes. Méthodes Étude rétrospective menée sur des dossiers de patients hospitalisés à l’unité COVID 19 entre octobre 2020 et juin 2021. Au total, parmi 501 patients, 456 données de TDM étaient disponibles et ont été classées selon le temps après l’apparition des premiers symptômes, à savoir le stade 1 (0–7 jours); stade-2 (8–14 jours); stade-3 (> 14 jours). Dans chaque Compte rendu de TDM les informations suivantes étaient précisées: L’étendue des lésions, présence de lésions en verre dépoli, de condensations, d’épanchement pleural et d’épanchement péricardique, ainsi que la répartition des lésions. Résultats La lésion prédominante était le verre dépoli (97,7%). L’étendue moyenne des lésions était de 46,8% ± 18% avec une répartition plus importante aux bases (91,9%). La fréquence des lésions en verre dépoli était stable au cours des trois stades (97%, 98,3%, 98,2%). Les condensations étaient présentes majoritairement au cours du stade 2 (70,1%; 77,1%, 69,8%). La présence d’épanchement pleural et d’épanchement péricardique a augmenté du stade 1 au stade 3, respectivement (9,9%, 7,8%, 17,9%) et (8%, 10%, 18,4%). L’étendue moyenne des lésions a augmenté du stade 1 au stade 3 (43,7%, 48,4%, 53%). Conclusion La TDM thoracique peut fournir une analyse semi-quantitative de l’étendue et de la gravité des lésions pulmonaires qui sont évolutives par rapport à la date de début de symptômes.

Background Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children and is one of the major causes of morbidity and physical disability.Due to frequent absences,children with chronic health impairments are also often confronted with educational difficulties. Objectives The aims of this study were to assess the impact of JIA on children9s schooling and to determine the factors that influence their school level. Methods This is a cross-sectional study including patients with JIA (ILAR criteria).A detailed questionnaire was completed for each participant by interviewing them or their parents as well as by information obtained from their medical records.Collected data included age,sex,subtype of JIA,disease duration,level of disability according to the Childhood Heath Assessment Questionnaire (CHAQ),visual analog scale for patient9s overall assessment of disease activity,duration of morning stiffness, joint counts,erythrocyte sedimentation rate,C-Reactive Protein,Disease Activity Score (DAS28).Medications used for JIA treatment were also documented. Data on the school performance of patients and their siblings were obtained using telephone interviews (educational level, absenteeism, school delay by repetition, drop-out). The comparison of quantitative variables was performed with the Mann-Whitney test and the comparison of qualitative ones was performed with the Chi square test. The significance level was set at 0.05. Results A total of 38 patients with JIA were included, 23 female and 15 male, with a mean age of 26 years [12–51] and a mean disease duration of 237 months [5–496].The average age of the onset of the disease was 7.4 years [1.5–16]. The most common subtype was rheumatoid factor-positive polyarthritis (n=16) followed by systematic (n=7), oligoarticular (n=6), rheumatoid factor-negative polyarthritis (n=5) and Enthesitis-related arthritis (n=4). The mean DAS28 was 2.63 [0.76 - 5.55] and the median CHAQ was 0.528 [0–3].Twenty-seven of the children were receiving corticosteroid. Disease-modifying anti-rheumatic drugs were used by 34 of the 38 patients: methotrexate (n=23), sulfasalazine (n=8),leflunomide (n=7),biotherapies (n=14). Twenty patients had complications:Hip arthritis (n=15), growth stunting (n=12), uveitis (n=4). Joint replacement was required in 9 cases. Four patients were illiterate,12 had dropped out of school,21 reported repeated absences due to illness.A year of schooling was repeated by 61.7% of patients.Ten out of 32 patients over the age of 20 had an university level.Almost 80% of patients were exempted of physical education. There were no significant associations between the school-related problems,the socio-demographic characteristics and the various parameters of clinical and biological activity studied.School failure was similar among patients and their siblings (p=0.05). Conclusions Our study suggested that JIA negatively affects schooling of children.More studies with a larger sample are needed to identify the variables associated with school failure in order to ensure the proper management of these patients and to increase their academic performance. References Bouaddi et al. Impact of juvenile idiopathic arthritis on schooling. BMC Pediatrics 2013,13:2. Kamrul Laila et al. Impact of Juvenile Idiopathic Arthritis on School Attendance and Performance. American Journal of Clinical and Experimental Medicine 2016;4(6):185–190. Disclosure of Interest None declared

Introduction La polyarthrite rhumatoide (PR) est le plus frequent des rhumatismes inflammatoires chroniques. La tomodensitometrie thoracique a bouleverse l’approche du poumon rhumatoide et a permis de decrire les differentes lesions qui sont le plus souvent intriquees. Le but de ce travail etait d’etablir une relation entre les donnees scanographiques et celles du lavage bronchiolo-aveolaire (LBA) et de la spirometrie lors de la PR. Methodes Il s’agissait d’une etude retrospective colligeant les dossiers de patients suivis conjointement dans les services de rhumatologie et de pneumologie du CHU Mongi-Slim La Marsa durant la periode allant de janvier 2017 a juillet 2019, pour PR avec atteinte pleuropulmonaire. Tous les patients ont eu une tomodensitometrie (TDM) thoracique de haute resolution avec des coupes fines ainsi que des explorations fonctionnelles respiratoires. Un LBA a ete realise en fonction de la presentation radio-clinique. Les analyses statistiques ont ete effectuees avec le Logiciel SPSS 25.0. Resultats Trente-six dossiers ont ete colliges (âge moyen = 58 ± 10 ans ; sex-ratio F/H = 2,27) dont 14 patients etaient tabagiques. L’evolution moyenne de la PR etait de 8 ± 6 ans. La TDM a montre une PINS dans 33 % des cas, des DDB dans 33 % des cas, une UIP dans 5 % des cas, des nodules pulmonaires isoles dans 29 % des cas et de l’emphyseme dans 19 % des cas. La CVF moyenne etait de 2,6 L/min (77 %), le VEMS moyen de 2,02 L/min (76 %) et la CPT moyenne de 3,97 (80 %). Quatorze patients ont eu un LBA dont douze etaient hypercellulaires (3 a predominance lymphocytaire, 4 a formule panachee et 7 normaux). La presence de verre depoli au scanner etait correlee de facon statistiquement significative au taux de PNE au LBA (p = 0,038), les DDB etaient associees a une hyper-reactivite bronchique avec amelioration du VEMS en post bronchodilatation (p = 0,05), l’emphyseme s’accompagnait d’une hyper-inflation sur la CPT (p = 0,021), la PINS etaient responsable d’une baisse des performances respiratoires sur la CVF et le VEMS (p = 0,047 ; p = 0,049), les micronodules s’accompagnaient de plus de PNN au LBA (p Conclusion La PR est responsable de manifestations thoraciques tres variables allant des simples nodules rhumatoides jusqu’aux lesions intriquees. Celles-ci peuvent predire des anomalies fonctionnelles respiratoires et celles du LBA et ainsi aider dans la prise en charge therapeutique.

Introduction L’association des troubles psychiatriques a l’epilepsie generalisee idiopathique (EGI) rend son pronostic moins favorable. Objectifs Decrire la prevalence, le type des troubles psychiatriques et leurs relations aux differents sous-types d’EGI. Methodes Nous avons realise une etude retrospective au service de neurologie a l’hopital Razi de Tunis, Tunisie s’etalant entre 2004 et 2016. Nous avons inclus tous les patients ayant une evaluation neuropsychologique. Resultats Parmi 400 patients suivis pour EGI, 21.5 % avaient des comorbidites psychiatriques (sex-ratio : 0.8, âge moyen : 45 ans). Le syndrome epileptique etait une epilepsie avec crises tonicocloniques generalisees (EGTC) : 71 %, epilepsie myoclonique juvenile : 18 %, epilepsie absence : 10 %. Les troubles psychiatriques etaient : depression (90 %), psychose (26 %) et troubles somatoformes (7 %). La depression etait associee dans 95 % des cas a l’ECTCG. Une persistance des crises etait notee chez les patients EGI souffrant de troubles psychiatriques. Discussion Les comorbidites psychiatriques surviennent au cours de differents types d’epilepsie et sont associees a plusieurs syndromes epileptiques, notamment l’ECTCG dans 71 % des cas dans notre etude et 36 % des cas dans la litterature. Les troubles de l’humeur sont domines par la depression conformement a la litterature. Conclusion Notre etude met en evidence une frequence elevee de comorbidite qui serait en rapport avec un biais de selection (proximites des services psychiatriques). Le traitement des troubles psychiatriques au cours des EGI est primordial pour ameliorer leur pronostic.

Celiac disease is reported to be common among North Africans, particularly Tunisians. Nevertheless, the prevalence of coeliac disease in the general population has not been previously investigated.This study aimed to determine the prevalence of celiac disease among children in Tunisia and to describe the clinical profile of the screened patients.A mass screening study based on drawing lots was carried out on schoolchildren in Ariana, a Tunisian district. A participation agreement was obtained from 6286 children (3175 boys, age: 9.7+/-3 years). Two children of known celiac disease were present in this population. All participants were tested for IgA antitissue transglutaminase antibodies (IgA-tTG) by a commercial enzyme-linked immunosorbent assay (ELISA) and total IgA levels. Sera, found positive by the initial screening, were assessed by immunofluorescence for the presence of IgA antiendomysium antibodies (IgA-AE). Positive participants were also called in for serological control, intestinal biopsy, biological exploration (hemoglobin rate, calcemia and albuminemia) and bone mineral densitometry.Among the 6284 participants, 139 (1/45) were positive for IgA-tTG. Forty-two of these had low-level IgA-tTG and no one had IgA deficiency. IgA-AE was detected in 40 participants. One hundred and seven children were called in, 28 had both positive tests (IgA-tTG +/IgA-AE+) and 79 were only positive for IgA-tTG (IgA-tTG +/IgA-AE-). Intestinal biopsy was performed in the 28 participants of the first group (IgA-tTG +/IgA-AE+) and confirmed celiac disease in 26 cases. In the second group (IgA-tTG +/IgA-AE-), intestinal biopsy was performed in 26 children and histological examination was normal in all cases. Among the 26 biopsy-proven celiac disease children, six (23%) had typical clinical symptoms of celiac disease, whereas the others had atypical forms with 11 (42%) asymptomatic. In 23 biopsy-proven celiac disease children, bone mineral density was significantly lower than that of a group of 109 normal children (0.850+/-0.06 g/cm2 versus 0.912+/-0.06 g/cm2, P0.05). Seven participants (30.4%) among the celiac disease children and six (7.5%) among the controls had a total-body Z score for bone mineral density of-2 (P0.001).The prevalence of celiac disease in Tunisian schoolchildren, estimated to be about 1/157, is close to the European prevalence. Most of the screened children showed an atypical and asymptomatic form, but even the typical forms were underdiagnosed. Ostopenia was frequently observed in celiac disease patients.

Macrophage activation syndrome (MAS) has been rarely reported in the course of adult-onset Still’s disease (AOSD) and in the majority of cases, it was triggered by an infection. Here, we report, to our knowledge, the first case of MAS occurring after adalimumab treatment initiation and not triggered by an infection. A 26-yearold woman with classical features of AOSD developed persistent fever, severe bicytopenia associated with extreme hyperferritinemia, hyponatremia and abnormal liver function two months after the initiation of adalimumab treatment. The diagnosis of MAS was made without histological proof. The patient was treated with methylprednisolone pulse therapy and her condition improved. During the disease course, extensive studies could not identify any viral infection or other known underlying etiology for the reactive MAS. The adalimumab was incriminated in this complication. Currently, the patient is in remission on tocilizumab and low-dose prednisoloneKey words: Adult-onset Still´s disease, macrophage activation syndrome, hemophagocytic syndrome, adalimumab

Mycetoma is a chronic granulomatous infection of bacterial (actinomycetoma) or fungal origin. It is uncommon in Maghrebian countries. We report on the case of a 44-year-old Tunisian woman with a 15 year history of actinomycetoma involving the foot. The diagnosis was based on clinical and bacteriological arguments. An X-ray revealed bone lesions by contiguity. The patient was treated with combined antibiotic therapy.