Tunisian Population Research Articles

Food Habits and Dietary Patterns of the Tunisian Population

Food Habits and Dietary Patterns of the Tunisian Population

Trends in diabetes morbi-mortality and its association with abdominal obesity among Tunisian adults

Abstract Introduction Tunisia is undergoing rapid nutritional transition, with increasing rates of abdominal obesity. Coupled with rising diabetes prevalence, it poses significant challenges to public health. This study aimed to estimate the morbi-mortality prevalence and trends of diabetes among Tunisian adults, particularly examining its association with abdominal obesity. Methods We conducted a secondary data analysis on adults aged 35 to 70 from three national surveys in Tunisia, in 1996 (n = 3513), 2005 (n = 7700), and 2016 (n = 6007) respectively. Mortality data was sourced from the Tunisian National Information System on Causes of Death in 2020. The underlying cause of death was determined using the IRIS software, following WHO guidelines for tabulating mortality statistics. Diabetes was defined according to the American Association of Diabetes criteria. Abdominal obesity was defined as a waist-to-height ratio ≥ 0.6. We performed chi-squared test for trend analysis. Results A total of 17220 participants were analyzed. We found a significant upwards trend in diabetes prevalence (p < 10-3): it increased from 13.1%[11.9-14.3] in 1996 to 15.1% [12.5-17.4] in 2005, then to 20.5%[18.9-22.1] in 2016. Linear trend test concluded to significant increase in diabetes prevalence estimated at 56.6% in two decades. Diabetes was significantly associated with abdominal obesity (Odds ratio (OR)=2.17[2.11-2.21]). Diabetes was the leading cause of death among Tunisian adults in 2020 (n = 22715). The proportional mortality due to diabetes was estimated at 6.2% (n = 1407) (6.4% for men and 6% for women). The age group with the highest proportional mortality due to diabetes was 65-70 years old (44.6%). Conclusions Our findings highlight the burden of diabetes on public health in Tunisia and its association with abdominal obesity. Hence the urgency to strengthen comprehensive preventive and control measures to alleviate its repercussions among the Tunisian population. Key messages • The prevalence of diabetes increased significantly amongTunisian adults in the past two decades. • Immediate implementation of targeted interventions and policy measures is imperative to effectively address this issue.

Evaluation of Previous ECG Algorithms for Identifying the Culprit Artery in Inferior STEMI

Abstract Background ST elevation myocardial infarction (STEMI) is the leading cause of cardiovascular related mortality. In the context of Inferior STEMI, the culprit artery is whether the right coronary artery (RCA) or left circumflex coronary artery (LCx). An accurate prediction of culprit artery prior to primary percutaneous coronary intervention (PCI) could improve the door-to-balloon time and could prevent contrast-induced-nephropathy. However algorithms established for that purpose were not evaluated within the Tunisian population. We aimed then to assess their performance in our population Methods We conducted a single-center hostorical cohort study from January 2014 to December 2022 on patients admitted at Sahloul university hospital Sousse Tunisia for PCI following an inferior STEMI. We analyzed the ST segment deviations at the J-point and 80 ms after the J-point then evaluated the performance of previous algorithms. Results We collected data from 156 patients, of which 130 (83.3%) hada RCA occlusion, and 26 (16.7%) a LCx occlusion. We evaluated 19 published algorithms. The criterion of zimetbaum et al (ST elevation in III> II and I and/or VL <-1 mm) had the highest AUC 0.77[0.66 - 0.88] YI = 52 accuracy = 0.81. The criterion of Herz et al (ST III > II) had AUC ROC of 0.71 [0.58 - 0.83] YI = 0.41 accuracy = 0.78, the algorithm of Tierala et al: AUC = 0.70[0.58 - 0.83] YI = 0.40 accuracy = 0.78. The algorithm og Fiol et al: AUC = 0.79 [0.58-0.83] YI = 0.59 accuracy = 0.73. Conclusions The Zimetbaum criterion had the highest performance in predicting the culprit artery and Fiol’s algorithm was the most specific to the LCx occlusion in our population. Further study on the impact of these algorithms on patients outcome is necessary. Key messages • The prediction of the culprit artery in inferior STEMI is challenging. • The criterion of Zimetbaum et al had a good performance for that regard.

Memory impairment after one year of the acute episode of Covid-19 infection

Abstract Introduction Memory impairment is one of the most frequently reported sequelae of COVID-19 infection. The aim of our study was to estimate the risk of memory disorders one year after the acute episode of COVID-19 infection in the Tunisian population of Monastir. Methods This is a cohort study conducted in Monastir University Hospital. The study included two groups: Exposed subjects were randomly selected among those with a positive diagnosis of COVID-19 between September 2021 and January 2022. The non exposed group was selectd among subjects with a negative COVID-19 diagnosis during the same period and who had no COVID infection during the following year. The Mac Nair scale was used to assess memory impairment after one year of follow up. Results Our study included 140 subjects diagnosed with Covid-19 and 139 subjects who had never been in contact with this virus. The incidence rate of memory impairment at one year post-Covid-19 infection was 17.9% (IC95% [11.5 - 24.2%]), whereas in the non exposed group it was 9.4% (IC95% [4.45% -14.5%]). Multivariate analysis revealed that the group exposed to Covid-19 had a significantly higher Mac-Nair Total score after one year of the acute episode of infection compared with the non exposed group (exp β = 1.25, IC95% [1.10; 1.42]). The other main predictors of memory impairment in the study population were age (exp β = 1.006, IC95% [1.001; 1.01]), diabetes (exp β = 1.67, IC95% [1.44; 1.95]), history of anxiety and depression ((exp β = 1.71, IC95% [1.35; 2.17]) and obesity (exp β = 1.25, IC95% [1.10; 1.42]), whereas vaccination with two or more doses prior to COVID-19 infection (exp β = 0.84, IC95% [0.74; 0.96]) and male gender (exp β = 0.65, IC95% [ 0.57; 0.73]) were found to be protective against these disorders. Conclusions Our study allowed us to estimate the risk of long-term memory disorders following Covid-19 infection. This could help better guide preventive measures to reduce the incidence of these disorders. Key messages • The incidence rate of memory impairment at one year post-Covid-19 infection was 17.9%. • The main other predictors of memory impairment were age, female gender, diabetes, history of anxiety and depression and obesity whereas vaccination prior to COVID-19 infection was a protective factor.

Prevalence and Predictors of Root Resorption Associated with Maxillary Canine Impaction in an Orthodontic Tunisian Population: An Analytical Cross-Sectional Study

The main objective of this study was to determine the occurrence of root resorption of adjacent permanent teeth associated with impacted maxillary canines and to identify a predictive model for RR by means of orthopantomographic variables, with the intention of reducing the need for additional cone beam computed tomography (CBCT) imaging. Materials and Methods: The sample consisted of 70 consecutive patients (43 females and 27 males, with a mean age of 17.03 years). A total of 90 impacted maxillary canines and adjacent teeth were analyzed using panoramic and CBCT radiographs. Univariable and multivariable analyses were respectively evaluated using chi-square test, Student's t-test, and binary logistic regression analysis. Results: The prevalence of root resorption of the permanent teeth adjacent to the impacted canine was more frequent in females than in males (ratio 1.8), but without significant association. No relationship was found between the sex, the type, the side, and the buccopalatal position of the impacted canine and root resorption. A statistically significant relationship was noted between the canines located mesial to the midline of the lateral incisor and root resorption on the maxillary incisors. Therefore, adjacent root resorption caused by impacted maxillary canines can be affirmed to exhibit a greater amount of resorption as the position proximity of the canine crown and lateral incisor root increases. In this prediction model, the patient’s age, the mesio-distal position, and the inclination of the impacted canine were the strongest predictors for RR. Conclusion: The final prediction model for RR based on the available panoramic radiographs could be a helpful tool in justifying the need of additional CBCT examination.

Assessment of renal response in Tunisian patients with proliferative lupus nephritis under three different induction immunosuppressive agents: A prognostic retrospective study.

The aim of our study was to evaluate the renal response (RR) of three immunosuppressive protocols in the induction treatment of proliferative lupus nephritis (PLN) in a Tunisian population. We performed a retrospective prognostic cohort study in the Internal Medicine Department of the Habib Thameur University Hospital in Tunis from January 2000 to December 2023, and included kidney biopsy proven proliferative lupus nephritis patients. Three induction treatments were compared: High CYP regimen: glucocorticoids (GC) + IV cyclophosphamide (CYP) in monthly pulses of 0.7g/m2 for 6 months; Low CYP regimen: GC + IV CYP in biweekly pulses of 500mg for 3 months; and MMF regimen: GC + oral MMF 1.5g twice daily for 6 months. The primary endpoint was the incidence of RR (complete and partial remission) at one year post-diagnosis. The additional outcomes were end-stage kidney disease (ESKD), severe adverse events (AEs) and death. Our study included 78 PLN patients (High CYP: 17, Low CYP: 40, MMF: 21). The study found that 94.1% of patients receiving High CYP achieved the primary endpoint, RR, compared to 67.5% of those receiving Low CYP and 61.9% in the MMF group. For the additional outcomes, there were 3 cases of ESKD, all in the Low CYP group, 5 cases of death (4 in the Low CYP group and 1 in the MMF group), and 20 cases of severe AEs, all of which were severe infections (5 in the High CYP group, 12 in the Low CYP group, and 3 in the MMF group). Multivariate analysis showed that the High CYP regimen was more associated with RR than the MMF regimen, with an adjusted OR of 9.846 (95% CI: 1.087-98.210); p = 0.042. Multivariate analysis did not show statistically significant differences between the High CYP regimen and the Low CYP regimen in terms of RR. As an induction treatment for PLN, the High CYP regimen was strongly associated with a higher rate of RR than the MMF regimen. There were no statistically significant differences between the High CYP regimen and the Low CYP regimen in terms of RR.

Arabic validation of the Body-Esteem Scale for Adolescents and Adults

ObjectivesThe aim of this study was to validate the questionnaire “Body-Esteem Scale for Adolescents and Adults” (BESAA). MethodsWe conducted a cross-sectional study involving 340 adolescents who attend a Tunisian high school. We translated the BESAA into dialectal Tunisian Arabic based on the translation back-translation method. The validity of the scale was evaluated through content validity, reliability and construct validity. We used the Arabic version of the Rosenberg Self-Esteem Scale as an external validator. The cut-off of the scale was calculated using the ROC curve. ResultsThe translated version was considered satisfactory. The exploratory analysis related three factors similar to the original version of the questionnaire. We dropped eight items (1, 4, 6, 14, 15, 18, 19 and 23) and obtained a 15-item version. A principal component analysis was carried out of the new version and produced a three-component solution that accounted for 64.56% of the total BESAA variance. In confirmatory analysis, the scale demonstrated good model fit statistics as follows: Comparative Fit Index=0.92; Goodness of Fit Index=0.89; Adjusted Goodness of Fit Index=0.85; Root Mean Square Error of Approximation=0.13 and Standardized Root Mean Square Residual=0.09. The internal consistency showed a good result with a Cronbach's alpha of 0.753. The correlation between items and subscales demonstrated statistically significant and logical results. Statistically significant correlations were found between the BESAA and its external validator the Rosenberg Self-Esteem Scale (r=0.382; P<0.01). The cut-off of our scale was equal to 24.5. ConclusionsThe Tunisian 15-item version of the BESAA is a psychometrically valid measure. This scale can be reliably used to conduct further studies and research on body esteem in the Tunisian population.

First Molecular and Phylogenetic Identification of Toxoplasma Gondii in Sheep Liver Intended for Human Consumption in Northern Tunisia.

The aim of this study was to estimate the molecular infection prevalence of Toxoplasma gondii in sheep liver tissues destined for human consumption. A total number of 224 liver tissues were collected from slaughtered sheep in Sejnane slaughterhouse (Northwest Tunisia). PCR was used to detect T. gondii DNA in liver tissues followed by phylogenetic analysis of amplicons. The phylogenetic tree was then constructed to compare the partial sequences of the ITS1 gene with GenBank sequences.The overall molecular prevalence of T. gondii in sheep livers was 25% (56/224). The highest molecular prevalence of T. gondii was recorded in sheep aged of less than one year old (27.3%; 52/190). Infection prevalence was significantly higher in Noire de Thibar breed (33%; 17/51) compared to other breeds (p = 0.023). There were no differences depicted according to sheep's gender. The T. gondii sequences obtained in the present study (GenBank accession numbers: OR509829 and OR509830) were 98.40-100% homologous to T. gondii sequences published in the GenBank. These results highlight a high level of T. gondii contamination of tissues destined for human consumption. Further studies are needed to improve our knowledge on different genotypes of T. gondii that infect Tunisian sheep population.

Predictors of Drug Retention and Survival Rate of bDMARDs in Rheumatoid Arthritis: A Four-Year Real-Life Tunisian Experience.

This study aims to investigate the efficacy and tolerance of biologic disease-modifying anti-rheumatic drug (bDMARDs) in the current management of rheumatoid arthritis (RA) by identifying the retention time and survival rate of bDMARDs. We conducted a retrospective cohort study including Tunisian patients initiating bDMARD treatment between 2016 and 2018 whose data were collected from the National Health Insurance Fund (NHIF). The NHIF is the national office which organises and centralises patients under bDMARDs from all over the country. Retention and survival rate of bDMARDs at 48 months were analysed using Kaplan-Meier survival curves and compared using the log-rank test. Survival factor analysis was performed using Cox regression. Three hundred seventy-four patients, aged 55.5±12.5years [20-90], (87.2%women), were included. The mean duration of RA was 11.7±6.7 years [2-41]. The mean disease activity score (DAS)28 at initiation of the first bDMARD was 6.01±0.89 [5.37-6.5]. This first bDMARD induced low disease activity (LDA) in 55% of cases. Remission was observed in 28% of patients. The highest LDA and remission rates were observed with Tocilizumab (70.8% and 33.3% of cases, respectively). LDA and remission were achieved within a mean of 45 weeks [26-88] and 72 weeks [31-117] respectively. The 48-month first-line survival rate was 55.9%. Retention time was 41.7 months, 95%CI [39.47-43.91]. Presence of rheumatoid factors, co-prescription of methotrexate, and good initial therapeutic response were factors influencing better survival of bDMARDs (p<0.01). Glucocorticoid use predicted poorer survival (p<10-3). The first bDMARD was interrupted in 39% of cases. Ineffectiveness was the most common cause of treatment cessation (52.7%). This real-life study of the Tunisian population allowed us to establish the factors that can influence the survival and retention rates of bDMARDs.

Distribution of CYP3A4 and CYP3A5 Polymorphisms and Genotype Combination Implicated in Tacrolimus Metabolism.

Human cytochrome P450 (CYP), particularly CYP3A4 and CYP3A5 is mainly responsible for the metabolism of several drugs including tacrolimus. Significant interracial/interethnic variation in the expression and function of CYP3A5 and CYP3A4 is caused by Single Nucleotide Polymorphisms (SNPs) of genes encoding these proteins. The present study investigated the genetic polymorphisms CYP3A4*1B, CYP3A4*22, and CYP3A5*3 in the Tunisian population. We included in this study, Tunisian healthy subjects and renal transplant recipients receiving tacrolimus. CYP3A4 and CYP3A5 genotyping were performed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). According to the genotypic combination of the three CYP polymorphisms, we have identified for the first time four metabolizers statuses: slow metabolizers (SM), intermediate metabolizers (IM), high metabolizers (HM), and extensive metabolizers (EM). A total of 101 renal transplant patients and 102 healthy subjects were included. Our results showed that the predominant alleles in the Tunisian population are a wild type of CYP3A4*1B (0.87), likewise CYP3A4*22 (0.975) and CYP3A5*3 (0.82). The genotype frequencies of CYP3A4*1B, CYP3A4*22, and CYP3A5*3 were found to be 3.9%, 0.0%, and 69.5%, respectively. Also, we found a significant linkage disequilibrium between CYP3A4*1B and CYP3A5*3. We approved that the IM is the predominant phenotype in our population with 124 patients followed by and EM with 41 patients, HM in 29 patients and SM in 9 patients. These results showed that Tunisians are most similar to Caucasians. The genetic background of these enzymes CYP3A4*1B, CYP3A4*22, and CYP3A5*3 in this study are important in the prescription of personalized medicine.

Effect of a physical activity program "ZENGYM" on metabolic syndrome control in Tunisian female population

Effect of a physical activity program "ZENGYM" on metabolic syndrome control in Tunisian female population

Effectiveness of physical activity program « ZENGYM » on cardiovascular disease risk in a female Tunisian population.

Effectiveness of physical activity program « ZENGYM » on cardiovascular disease risk in a female Tunisian population.

Genetic study of Alport syndrome in Tunisia.

Alport syndrome is a genetic disorder affecting the kidneys, ears, and eyes, causing chronic kidney disease, sensorineural hearing loss, and ocular abnormalities. It results from pathogenic variants in the COL4A3, COL4A4, or COL4A5 genes, with different inheritance patterns: X-linked from COL4A5 variants, autosomal recessive from homozygous variants in COL4A3 or COL4A4, digenic from variants in both COL4A3 and COL4A4, and autosomal dominant from heterozygous variants in COL4A3 or COL4A4. We analyzed 45 patients with Alport syndrome from 11 Tunisian families to determine their clinical and genetic characteristics. Clinical data were collected retrospectively, and whole-exome sequencing was conducted on one patient from each family. Sanger sequencing validated pathogenic variants, and cascade screening extended the analysis to 53 individuals. We identified nine likely pathogenic variants among 11 index cases: six novel and three known variations. Of these, five were in COL4A3, and four were in COL4A5, with variants including frameshift, nonsense, missense, and alternative splicing. Most variations affected the Gly-XY codon. Among the 45 clinically identified siblings, 30 tested positive for Alport syndrome. The cascade screening identified 3 additional affected individuals, 10 unaffected siblings, and 10 unaffected parents. The mode of inheritance was autosomal recessive in six families and X-linked in four families. This study is the first to screen the mutational spectrum of Alport syndrome in Tunisia. It reveals novel pathogenic variants and suggests that autosomal recessive inheritance may be more common in the Tunisian population than X-linked inheritance, contrary to existing literature.

Description of clinical profile, acute complications and glycemic control after Ramadan fasting in a Tunisian population of patients with diabetes

Description of clinical profile, acute complications and glycemic control after Ramadan fasting in a Tunisian population of patients with diabetes

Comparison of long-term anti-RBD SARS-CoV-2 antibody response following different vaccination schemes in Tunisia.

The study aimed to compare long-term vaccine-induced humoral immunity following different vaccines regimens. Anti-S-RBD total antibody levels were measured in blood samples of 167 participants nearly 6 months post-vaccination. Participants had received one; two or four doses of Pfizer vaccine or who received a third dose of mRNA vaccine (Pfizer) and primed with mRNA (Pfizer/Moderna), adenoviral (AstraZeneca/Jonson & Jonson) or inactivated (CoronaVac/Sinopharm) vaccine. Among all vaccination regimens, fourth dose of Pfizer achieved the highest S-RBD antibody titers. Nevertheless, the third dose of mRNA vaccine primed with adenoviral vaccine achieved the lowest titers of S-RBD antibody. Notably, the group that received a third dose of mRNA primed with two doses of mRNA vaccine exhibited higher S-RBD antibody compared to groups inoculated with a third dose of mRNA and primed with inactivated or adenovirus vaccine. Our data showed the superiority of three mRNA vaccinations compared to third heterologous vaccine (inactivated of adenoviral) including mRNA as booster in terms of humoral immunogenicity. Our findings supporting the use of additional booster shot from a more potent vaccine type such as mRNA vaccines. Nevertheless, due to the limited number of subjects, it is difficult to extrapolate the results of our study to the whole of Tunisian population. Future studies should investigate a larger cohort and other potential correlates of protection, such as cellular immunity and how it is affected by different vaccination schemes after long-term post-vaccination.

Carriage Rate of Enterobacterales Resistant to Extended-Spectrum Cephalosporins in the Tunisian Population.

Enterobacterales resistant to extended-spectrum cephalosporins (ESC) are a marker of the antimicrobial resistance (AMR) burden. They are infecting humans, but the intestinal microbiota can also be transiently colonized without developing symptoms. Healthy carriage can promote silent dissemination of resistant bacteria, and data on this colonization are often lacking. Between 2021 and 2023, a sampling of healthy Tunisian people was carried out. Fecal samples (n = 256) were plated on selective agar, and all collected isolates were characterized by phenotypic (antibiograms) and genomic (whole-genome sequencing) methods. A total of 26 (26/256, 10.2%) isolates were collected, including 24 Escherichia coli and 2 Klebsiella pneumoniae. In total, 17 isolates (15 E. coli and 2 K. pneumoniae) presented an ESBL phenotype conferred by the blaCTX-M-15 gene, and 9 E. coli isolates presented an AmpC phenotype conferred by the blaDHA-1 gene. K. pneumoniae belonged to ST1564 and ST313, while E. coli belonged to diverse STs including the pandemic ST131 clone. Clonally related ST349 E. coli isolates carrying the blaDHA-1 gene were found in nine individuals. In parallel, four blaCTX-M-15 -positive E. coli isolates carried this ESC-resistance gene on an epidemic plasmid IncF/F-:A-:B53 previously identified in Tunisian pigeons and fish. These findings highlight the spread of genetically diverse ESC-resistant Enterobacterales as well as an epidemic plasmid in Tunisia, emphasizing the need for antimicrobial stewardship to limit the transmission of these resistances in the Tunisian population.

Oral Colonization by Different Candida Species: First Comparative Study between Denture and Nondenture Wearers in Tunisia.

This study aimed to compare different Candida species present in patients with and without removable dentures to identify alterations in biofilm composition following denture wear within a Tunisian population. A cross-sectional study was conducted, comprising a group of patients wearing removable dentures (test group) and a control group without dentures. In the test group, two mycological samples were obtained: one from the prosthetic intaglio and another from the osteomucosal area bearing the denture. For the control group, mycological samples were collected from the oral mucosa. The collected swabs were cultured on CHROMagar Candida medium, and yeast counts were quantified as colony forming units (CFUs). Candida species were identified through chromogenic analysis. The normality of quantitative variables was evaluated using the Kolmogorov-Smirnov's test. To compare means and ranks between the test and control groups, the independent samples t-test and the Mann-Whitney's U test were employed, respectively. Qualitative variables were compared using Fisher's exact test. Statistical significance was determined at a critical uncertainty value of p < 0.05. A total of 150 participants were involved in this study, with 75 patients in each group. Wearing an acrylic removable denture was found to increase the number of detected Candida species (p < 0.001) and significantly increases the overall growth of Candida spp. (p = 0.001). Specifically, the numbers of CFUs of Candida tropicalis and Candida glabrata were elevated in denture wearers (p < 0.001). Findings stemming from this study indicate that removable dentures promote the growth of Candida species. This can be a predisposing factor for Candida-associated denture stomatitis in cases of poor oral hygiene or compromised immunity. Therefore, it is imperative to emphasize the fabrication of high-quality dentures and the implementation of rigorous postdenture maintenance protocols to prevent or limit Candida infection.

IL-10 polymorphism genotypes, haplotypes, and diplotypes are associated with colorectal cancer predisposition and outcome in Tunisian population

Background and aimAs the presence of single nucleotide polymorphisms (SNPs) in the interleukin (IL)-10 gene continues to be a major challenge in the development of effective therapies for digestive cancers, this case-control study was conducted to assess the possible influence of genotype, haplotype and diplotype for two SNPs (−1082A/G (rs1800896) and −592A/C (rs1800872)) located in the promoter region of IL-10 gene on the incidence, severity and prognosis of colorectal cancer (CRC) in Tunisians. MethodsIL-10 gene SNPs were analyzed in 130 CRC cases and 165 healthy subjects (HS) using PCR-SSP. ResultsFor the IL-10 -1082A/G SNP, the comparison of genotype frequencies between cases and HS groups showed that the G allele significantly reduced CRC risk under the recessive model (GG vs. AA + AG: OR [95%CI] = 0.44 [0.21–0.93], p = 0.03). Conversely, a positive association was observed between the codominant model (AG vs. AA + GG) and high susceptibility (OR [95%CI] = 1.65 [1.02–2.63], p = 0.04). After stratification by disease site, the recessive model was also found to reduce susceptibility to colon cancer (OR [95%CI] = 0.18 [0.04–0.72], p = 0 0.01), while the homozygote model (AA vs. GG) was suggested as a risk factor (OR [95%CI] = 5.16 [1.31–23.26], p = 0.02). Furthermore, the codominant model (AG vs. AA + GG) doubled the risk of rectum cancer (OR [95%CI] = 1.98 [1.07–3.70], p = 0.03). For the IL-10 -592A/C SNP, the codominant model (AC vs. AA + CC) has a protective effect against the development of CRC (OR [95%CI] = 0.59 [0.36–0.94], p = 0.03). The IL-10 gene haplotype was not associated with CRC risk. A stratified analysis by disease site demonstrated that the presence of Hap3 (−1082G and −592C alleles) specifically reduced the risk of developing colon cancer (OR [95%CI] = 0.51 [0.32–0.80], p = 0.003). Moreover, homozygous Hap3/Hap3 diplotype significantly reduced susceptibility to CRC (OR [95%CI] = 0.35 [0.14–0.85], p = 0.02). Interestingly, this diplotype has not been identified in colon cancer patients. Kaplan-Meier analysis showed that the homozygous Hap2/Hap2 diplotype was significantly associated with decreased overall survival (Log-rank: p = 0.01). This association was also observed in the colon cancer subgroup (Log-rank: p = 0.001). ConclusionOur findings provide preliminary indications that the −1082A/G and −592/AC SNPs within the IL-10 gene may exhibit significant associations with the pathogenesis and prognostic outcomes of CRC. However, further investigations are still warranted to validate and establish the veracity of our findings.

Sustained metabolic dysregulation and the emergence of diabetes: associations between HbA1c and metabolic syndrome components in Tunisian diabetic and nondiabetic groups

IntroductionMetabolic Syndrome (MetS), diabetes, and other noncommunicable diseases (NCDs) have been a major focus of research in recent decades as the prevalence of these conditions continues to rapidly increase globally. However, the timing and patterns of development from metabolic risk factors to disease states are less well understood and are especially critical to understand in low- and middle-income countries (LMICs) and populations undergoing epidemiological transitions.MethodsNationally representative sociodemographic, anthropometric, and point-of-care biomarker data from the 2016 Tunisian Health Examination Survey (n = 8170) were used to determine the prevalence of diabetes and MetS components in Tunisia and to investigate associations between glycated hemoglobin (HbA1c) and MetS components (blood pressure [BP], HDL cholesterol [HDL], triglycerides [TG], and waist circumference [WC]) in participants aged 15-97 years old. To better understand how sustained metabolic dysregulation and disease states impact these associations, diabetic and nondiabetic groups were analyzed separately.ResultsThe overall prevalence of diabetes based on measured HbA1c was 18.2%. The diabetic groups had a higher prevalence of each individual MetS component, and significantly higher (BP, TG, WC, and HbA1c) and lower (HDL) values than the nondiabetic groups. Yet, there were a higher number of significant associations between HbA1c and MetS components found in nondiabetic women and men when compared to diabetic women and men. HbA1c was positively associated with the cumulative number of MetS components, irrespective of diabetes status in men and women.ConclusionsThe prevalence of both diabetes and MetS components (particularly low HDL cholesterol and elevated TG) is high among the Tunisian population. More MetS components were associated with HbA1c in nondiabetic individuals, showing a strong connection between the development of MetS components and diabetes. However, once the diabetes disease state manifests, there is more variability in the relationships. These results show the potential for HbA1c to be an indicator of metabolic health below clinical disease cutoffs, which may allow insights into the physiological changes that precipitate the emergence of diabetes.

Association of HLA-G 3'UTR polymorphisms with hepatitis B virus infection in Tunisian population.

Hepatitis B virus (HBV) infection is a major public health burden. The mechanisms of immune evasion during chronic HBV (CHB) infection are poorly understood. Human leukocyte antigen (HLA)-G, an immune checkpoint molecule, plays a crucial role in the tolerance mechanisms of various infectious diseases. The 3' untranslated region (3'UTR), including the HLA-G + 3142 C > G polymorphism (rs1063320) and the 14-pb Ins/Del (rs66554220) has been strongly suggested to influence HLA-G expression. This study conducted a case-control analysis to evaluate the potential correlation between the HLA-G + 3142 C > G polymorphism and HBV infection outcome in a Tunisian cohort. The HLA-G + 3142 C > G polymorphism was analysed by PCR-RFLP in 242 patients with chronic HBV infection (116 males and 126 females), 241 healthy controls (116 males and 125 females), and 100 spontaneously resolved subjects (52 males and 48 females). Patients with chronic HBV infection showed a higher frequency of the + 3142G allele compared to healthy controls and spontaneously resolved subjects (p = 0.001 and p = 0.002, respectively). An association between the + 3142G allele and high HBV DNA levels was observed when HBV patients were stratified based on their HBV DNA levels (p = 0.016). Furthermore, the dominant model (GG + GC vs CC) was associated with liver function parameters, including AST, ALT, and high HBV DNA levels (p = 0.04, p < 0.001 and p = 0.002, respectively). However, there was no significant association found between this polymorphism and the fibrosis stage (p = 0.32). The haplotype analysis, using a subset of previously published data on the HLA-G 14-pb Ins/Del polymorphism, revealed an association between the Ins/G haplotype and chronic HBV infection (H1: InsG, p < 0.001). Our findings suggest that the + 3142G allele is a risk factor for the persistence and progression of HBV infection, while the + 3142C allele serves as a protective allele associated with the spontaneous resolution of the infection. Additionally, the HLA-G 3'UTR haplotype Ins/G is associated with chronic HBV infection in the Tunisian population.