[ outcome of 105 Tunisian pediatric patients with sickle cell disease]

Sickle cell disease is widespread in the world. It is a public health problem in Tunisia. In this paper, we will study the outcome of 105 Tunisians infants affected by this disease. It is a retrospective study over 8 years, enrolling 105 Tunisian infants with sickle cell disease. Their main age is 10 years 7 months [19 months-18 years]. They are distributed into 58 boys and 47 girls. Sixty two of them ate homozygotes S/S, and 43 are double heterozygotes [S/, thalassemics 41 cases, S/O arab=1 case, S/C=1 case]. The main acute complications were vaso occlusive crises in 85 patients. They essentially reach the limbs. One hundred and twenty one events acute anemia" were observed. They are distributed into 107 events splenic sequestration [884%] and 14 events erythroblastopenia [11.6%]. Eleven of our patients [10.4%] have presented 16 events ischemic cerebral vascular [strokes]. Twenty events acute chest syndrome were observed in 15 patients [14.3%]. Infectious complications were noted in 83 patients [79%]. The priapism was observed in only 4 boys out of 58. The chronic degenerative complications were as follows: Femur head necrosis in 9 cases, degenerative retinopathy in one case and ulcer leg in one case. Hydroxyurea was reserved to 30 patients with a severe form of the disease. All of them improve the clinical outcome as attested by the number of days of hospitalisation/patient/year, which drops from 30 days to 3 days only [p<0,001]. We not deplore any death. By its complications, sickle cell disease is a potentielly serious disease. Hydroxyurea is an efficient treatment for the most severe forms

[Protein profile - concept and clinical interest]

The protein profile consists in a simultaneous assay of many proteins in serum that explores many physiopathological axes. The results are expressed in percentage of the median value [100%] related to the patient's age and sex. There are two types of protein profiles: a directed profile and a targeted profile. This exam which is based on the study of the correlation between proteins, has ameliorated the screening, the diagnosis and the survey of many biologic syndromes. The aim of this article is to review the concept of protein profile in the different biological syndromes

[Biological markers of osteoarthritis]

Osteoarthritis is the most frequent pathology of rheumatologic affections. With the progressive ageing of the populations, it becomes a major problem of public health. Active research is under way to clarify the pathophysiology and the prognosis of this disease and to identify new targets for treatments. Recently, the development of several biological markers measured in blood, urine and/or synovial fluid by immunological methods reflect the joint tissues remodelling. The most specific markers of articular formation are mainly N and C-propeptides of type Ii procohagen [PHANP and PIIC]. The activity of the cartilage degradation is indicated by the C-terminal telopeptide of type II collagen [CTX II] and COMP [cartilage oligometric matrix protein]. The hyaluronate constitutes the most used parameter for the evaluation of the activity of synthesis of the synoviocytes. The study of the interest of measuring the bone turnover markers during osteoarthritis showed contradictory results. Consequently, the interest itself is still not definite. As the evolution of osteoarthritis is unpredictable and there is no parallelism between the clinical and the radiological signs, the biological parameters could constitute predictive factors of the evolution of this pathology and direct the therapeutic attitude. A large number of studies would be necessary to standardize assay methods of these markers and to optimize their practical use

[About two cases of highly probable transfusion induced malaria]

Indigeneous malaria has not been seen in Tunisia since 1979. However blood transfusion has remained a cause of malaria transmission in our country. The last Tunisian transfusion induced malaria was diagnosed in 1985 We report two cases of malaria in two transfused patients documented in our laboratory in November 2003. The first case [patient 1] consisted of a Plasmodium falciparum malaria in a bone marrow transplanted patient; the second case [patient 2] was a Plasmodium malaria malaria, following blood transfusion for stomach surgery. Favourable outcome was obtained under intravenous quinine in patient 1, and oral chloroquine in patient 2. In both cases the relation between transfusion and malaria was not obvious. However, anamnesis showed a donor at risk [African origin] in patient 1, whereas the donor could not be identified at all in patient 2. We concluded that systematic screening of donors at risk would be the best way to prevent transfusion induced malaria in Tunisia

[Isosporosis in AIDS, about five Tunisian cases]

Isosporosis is a digestive parasitosis that occurs on a sporadic basis in our country. It is caused by a protozoan of coccidia class: Isospora belli. Between the years 2000 and 2004, five cases of isosporosis were diagnosed in our laboratory in five AIDS patients. Its prevalence among tunisian patients suffering from Human Iminunodeficiency Virus [HIV] infection in our series is about 1.41%. Main clinical manifestations consisted of acute diarrhea, with malabsorption syndrome in one case. Medical management based on specific antibiotics [sulfamethoxazole-trimethoprime], is efficient in avoiding recurrent episodes. However, recurrency remain frequent as long as immunity remains compromised