[ JAK2 mutation in myeloproliferative neoplasms: a predictive factor of thrombosis]

Background: BCR-ABL negative myeloproliferative neoplasms [MPN] include polycythemia Vera [PV], essential thrombocythemia [ET] and primitive myelofibrosis [PMF]. the JAK2 V617F mutation has been introduced since 2008 as a major diagnostic criterion on the one hand and on the other hand, it would be linked to increased risk of thrombotic complications

Aim: This study aimed to evaluate the association of JAK2 mutation and thrombotic events in MPN

Methods:A retrospective study concerning 45 BCR-ABL negative MPN patients [mean age=53 old years, sex ratio=0.8] was conducted

Results: They were classified as PV [22 patients], ET [17 patients], PMF [3 patients] and atypical MPN [3 patients]. The JAK2 mutation was found in 64.4% of patients: 72.7% of PV patients, 47% of ET patients and 66.7% of PMF patients. Thrombotic events were recorded in 11 patients [24.4%]. Cerebral arteries and portal vein were the most frequent localizations. The JAK2 mutation was an independent risk factor of thrombotic events

Conclusion: Consequently, it seems that screening for JAK2 mutation in BCR-ABL negative MPN could play a role in identifying patients at high risk of vascular complications

[Causes of vitamin B12 deficiency]

Background: B12 Vitamin deficiency is common in adults [20% of general population of industrialized populations], especially in elderly patients [30-40%]. The etiologies of Vitamin B12 deficiency have been dominated by the cobalamin syndrome nutrient and the Biermer disease, rarely by the intake or nutritional deficiency and bad absorptions

Study Objective: Establish an etiology of vitamin B12 in a Tunisian population

Methods: In a prospective study involving 100 patients with macrocytic anemia, a comprehensive assessment has been carried out of: B12 vitamin and folate intake, homocysteine, immunological assessment [antibodies, intrinsic anti-factor and anti-gastric parietal cells], an endoscopic exploration, and a dietary nutritional survey

Results: The mean age of patients was 53.6 +/- 17,6 years [13 - 88 years], the gender ratio [female/male] is 1.22. The clinical symptomatology shows a functional anemia syndrome in 89% of cases, a digestive syndrome in 88% of cases, and neurological disorders in 67% of cases. The intake of B12 vitamin was reduced [<180 pg/ml] in 99 patients, associated with a hyperhomocysteinemia in 81.63% of cases.The intrinsic anti-factor antibodies were positives in 32 patients, and the antibody anti-gastric parietal cells in 85 patients. Gastric biopsy was performed in 54 patients, showing a chronic atrophic gastritis of fundic localization in 44 patients, antral in 5 patients and pan- gastric in 3 patients. The diagnosis of Biermer anemia was held in 75% of patients, that of FCS in 16% of patients, and a lack of intake in 8% of patients. The etiology was undetermined in 1% of cases

Conclusion: Vitamin B12 deficiency is common in the general population, its causes and origins are multiple, we list them in order of occurrence: Biermer disease, the FCS, and the intake deficiency in our population

[Protein S, C and antithrombin deficiency: Association to myocardial infarction and thromboembolism in young]

The pathogenesis of myocardial infarction [MI] in young involves new factors including constitutional or acquired thrombophilia. To determine in patients

[Transfusion safety: state of the arts]

Blood transfusion is a high risk activity. To evaluate transfusion safety in planned cardiac surgery. This study was conducted in the blood bank of the Rabta Hospital in two phases: a phase to observe transfusion acts followed by corrective actions and a phase to evaluate the impacts of these corrections on the transfusion practices. Characteristics of the potentially transfused patients, the eventually prescribed, dispensed and transfused blood products and transfusion practices were studied. During the observation phase, 70 patients were enrolled, 51 potentially transfused. Weaknesses concerned the mention of phenotype and transfusion history when ordering blood components as well as the double ABO/D group typing, the phenotype and the cross match performing. Final bedside controls were done in a wrong way. The distribution and the blood administration were established respectively for 208 and 232 blood products. The traceability was established for 86 blood products. During the evaluation phase, 30 patients were enrolled, 15 potentially transfused. Improvement was achieved in the transfusion history notification, phenotype and antibodies screen performing and cross matching. Optimisation of blood transfusion can be conceived only with collaboration between the different transfusion structures

[Ocular manifestations of diabetics about 285 cases]

Diabetes is one of the principal cause of blindness in adults. The aim of the study is to evaluate the frequency of ocular complications and risk factors of diabetes. It's a multicentric prospective study on a representative sample of 285 diabetics. We performed a general and an ophthalmologic exam for all patients with retinal angiography and appropriate laboratory tests. Chi 2, Fisher, Mann and Whitney tests were used as statistical methods. Diabetic retinopathy was observed in 45, 2% of patients, cataract in 22%, glaucoma in 5%. Diabetic retinopathy frequency rises especially with duration of diabetes and bad glycaemic control. Blindness related to diabetic retinopathy was observed in 6, 25% and visual deficency in 12, 5%. The authors compared their results with litterature data. They emphasize on the great value of regular better glycaemic control and other associated metabolic disorders. We concluded that a regular ophthalmologic follow up is necessary for early diabetic retinopathy detection and treatment