[Impact of duration of untreated psychosis on quality of life and cognitive functions]. / Impact de la durée de psychose non traitée sur la qualité de vie et les fonctions cognitives.

OBJECTIVES: The duration of untreated psychosis is defined as the interval between the first psychotic symptoms and the first starting treatment. The duration of untreated psychosis is highly variable but often prolonged and may be influenced by several factors. Some studies suggested that duration of untreated psychosis is associated with poor outcome. The objectives of this study were to assess the duration of untreated psychosis in a Tunisian cohort and its impact on the quality of life and the cognitive functions of schizophrenic patients at 2 years. METHODS: We conducted a cross sectional study at Razi Hospital between January 2014 and June 2014 that included patients with Schizophrenia diagnosis as defined in the DSMIV-TR with regular monitoring for at least 2 years. Eligible participants are those who had been hospitalized for the first time, between January 2011 and December 2012 for a first psychotic episode. Data were collected from medical records and by interviewing the patients and their family. Duration of untreated psychosis was determined using the Symptom Onset in Schizophrenia Inventory. The quality of life was assessed by the 'Short Form-36 Health Survey' scale in its Arabic version. All patients were evaluated with 'The Tunisian Cognitive Battery' composed of 7 tests. Patient scores are expressed as 'Z scores', which represents the position of the scores in a term of standard deviation from the mean of healthy subjects established by the authors of the battery. We divided the population into two groups based on the duration of untreated psychosis median. A short duration of untreated psychosis was lower than the median, and a long duration of untreated psychosis was equal to or greater than the median. RESULTS: Our sample involved 42 patients with a mean age of 31.38 years. The average duration of untreated psychosis was 75.38 weeks with a range from 2 to 364 weeks and a median duration of 47.5 weeks. Patients with a short duration of untreated psychosis had a better quality of life with better scores for the majority of the dimensions and a significant difference in the limitations score due to the mental state (P=0.01). For cognitive function, the short duration of untreated psychosis was significantly correlated with a free recall of 'Hopkins Verbal Learning Test'. CONCLUSION: Our study suggest that the average duration of untreated psychosis in Tunisia is comparable to the one reported in the literature and that a short duration of untreated psychosis is correlated with better outcomes in terms of quality of life and verbal learning.

[Neuropsychiatric manifestations ushering pernicious anemia]. / Manifestations neuropsychiatriques inaugurant une maladie de Biermer.

Biermer disease or pernicious anemia is an autoimmune atrophic gastritis characterized by the lack of secretion of gastric intrinsic factor. This leads to an insufficient absorption of vitamin B12 in the ileum. Clinical manifestations are mainly hematologic. Neuropsychiatric manifestations are known but are less frequent especially early in the disease. Inaugural neuropsychiatric arrays are rare and various thus making diagnosis difficult. In this article, we report through two clinical cases different neuropsychiatric manifestations revealing pernicious anemia. Mrs. C.O., aged 56, presented after surgery for gallstones, an acute psychiatric array associated with gait disorders. She had no history of neurological or psychiatric problems. The psychiatric interview revealed delirious syndrome, depressive symptoms and anxiety. Neurological examination noted a flaccid paraplegia with peripheral neuropathic syndrome and myoclonus in the upper limbs. At the full blood count, a macrocytosis (VGM: 112.2fl) without anemia was found. The level of vitamin B12 in the blood was low. Cerebro-spinal MRI was suggestive of a neuro-Biermer and showed hyper signal in the cervical cord on T2-weighted sagittal section. In axial section, hyper signal appears at the posterior columns in the form of V. There were no brain abnormalities. A sensorimotor axonal polyneuropathy was diagnosed. The patient received vitamin B12 intramuscularly for ten days associated with neuroleptic treatment. Mrs. R.M., aged 40, was brought to the psychiatry consultation for acute behavioral disorders progressively worsening over a month. An anxiety syndrome, depressive syndrome and delirious syndrome were identified. Neurological examination showed a posterior cordonal syndrome with quadripyramidal syndrome. Full blood count showed a macrocytic anemia. Serum B12 level was collapsed. Cerebro-spinal MRI was normal. She received vitamin B12 with clinical and biological improvement. Features of pernicious anemia vary according to studies and age range. Digestive and hematological manifestations are well known. Neurological and psychiatric manifestations of pernicious anemia were also described in the early literature. They can be the initial symptoms or the only ones. However, inaugural neuropsychiatric features are often unrecognized. The most common psychiatric symptoms were depression, mania, psychotic symptoms, cognitive impairment and obsessive compulsive disorder. Neurological involvement includes mainly combined spinal sclerosis, peripheral neuropathy and dementia. Cerebellar ataxia and movement disorders are reported less often. Severity of neuropsychiatric features and therapeutic efficacy depends on the duration of signs and level of B12 deficiency. Macrocytic anemia may lack. Neuropsychiatric manifestations could be isolated or be the first manifestation of vitamin deficiency and occur without any hematological or gastrointestinal context. Pernicious anemia and serum B12 assay should be discussed in all patients with organic mental disorders, atypical psychiatric symptoms and fluctuation of symptomatology. Nevertheless, B12 level could be normal in genuine pernicious anemia diseases and macrocytic anemia may lack. Substitutive vitaminotherapy is required when diagnosis is strongly suspected and etiologic assessment is negative.

[Validation of the dialectal Arabic version of Barratt's impulsivity scale, the BIS-11]. / Validation de la version en arabe dialectal de l'échelle d'impulsivité de Barratt, la BIS-11.

INTRODUCTION: Impulsivity is a symptom of several disorders such as personality disorder, bipolar disorder, suicidal behaviour, substance use disorders, schizophrenia...Forensic psychiatry is particularly concerned with impulsivity. It increases the risk of violence among clinical populations and figures in various instruments such as the HCR-20, the VRAG and the PCL-R to assess violence risk. It is one of many dimensions that can lead to aggressive behaviour among psychiatric patients. The Barratt Impulsiveness Scale (BIS), in its 11th version, is a 30-item self-report instrument that helps assessing impulsivity trait among normal and clinical populations. The BIS is the most commonly administered self-assessment of impulsiveness. As of March 2009, there have been 551 citations of the BIS-11 among many publications. The purpose of the present study is to examine the psychometric properties of the Arabic translation of the BIS-11th version in a sample of the general population and to identify an eventual correlation between impulsivity and socio-demographic characteristics. PATIENTS AND METHODS: This is a prospective study conducted over a five-month period, from June to October 2010, and including 134 persons from the general population having provided their informed consent. The dialectal Arabic version was carried out by translation from English to dialectal Arabic followed by a back translation to English. Some questions were modified to be understood by a population with low education. After giving their verbal informed consent, the participants filled in the Arabic version of the BIS-11. For the illiterate, responses and quotations were performed by the interviewer. The persons were also asked to fill in socio-demographic data. Cronbach's coefficient was calculated, and then we assessed impulsivity prevalence and a correlation between demographic features and impulsivity scores. For the analyses, the statistical software SPSS 11 was used. RESULTS: The sex ratio is 1.02. Most of the interviewed persons were 20 to 49 years old. Around 25.4% of the sample were analphabets, 32.1% had primary education, 29.1% had secondary education and 13.4% were undergraduates. The Cronbach's alpha was respectively 0.66 for attention, 0.72 for motor impulsivity, 0.61 for lack of planning and 0.78 for total impulsivity. Factor analysis identified three factors explaining the total variance of 32.6%. Impulsivity prevalence was 9%. We did not find significant correlation between demographic features and impulsivity scores. DISCUSSION: Limits of the study: scale stability over time was not verified. This was due to the difficulty in re-inviting the same persons to fulfil the scale a second time. Because no instrument for assessing exists in Arabic, comparison was not possible between the translated Barratt's scale and the reference. Our sample represents the general population. This choice was justified in order to study an eventual correlation between impulsiveness and socio-demographic characteristics. We must mention difficulties when asking persons with low education to complete the scale, what may have caused a poorer performance of the scale due to difficulties in understanding some questions. Moreover, we had chosen a non-clinical sample. The validation of the scale could be performed in a clinical population. The measure of internal consistency (Cronbach's alpha) fell within an acceptable range (0.61-0.78), suggesting that the Arabic version of the BIS-11 is reliable. Exploratory factor analysis of the current version identified three factors, but these factors differed from those of other translated versions. CONCLUSION: There is growing interest in the impulsivity concept. Forensic psychiatry is particularly concerned by impulsivity. In fact, it is related to psychiatric patients' violence. Impulsivity also reveals the problem of responsibility assessment in psychiatric expertise and the dangerousness of psychiatric patients. The Arabic version of the BIS-11 has a good apparent and internal consistency. This version could be useful in assessing psychiatric patient's dangerousness.

[Stress and burnout among Tunisian teachers]. / Stress et épuisement professionnel des enseignants tunisiens.

INTRODUCTION: Burnout, or professional exhaustion syndrome, is defined as a state of emotional, mental and physical exhaustion caused by excessive and prolonged stress at work. Despite the fact that it is not a recognized disorder in the DSM-IV, burnout has been widely described among medical and paramedical staff. In Tunisia, all the studies about this syndrome have only considered populations of doctors. However, professional exhaustion syndrome is not only limited to the medical sector, but can also be seen in any profession involving a relation of help. Thus, the teaching profession seems to be concerned with this syndrome. In fact, in our clinical practice, we are increasingly confronted with teachers' suffering. The latter face increasing difficulties in their work and moreover some of them can no longer resist and thus become vulnerable to the professional exhaustion syndrome. OBJECTIVE: The aim of this study was to evaluate burnout among a population of Tunisian teachers and to examine the professional stressors associated with teachers' burnout. METHODS: Our study was a transversal study conducted over five months (from October 2009 to February 2010) and it concerned teachers working in the public high schools of Manouba (Tunisia). The participants completed a self-questionnaire dealing with professional stressors. Five types of professional stressors were identified in the literature: bad working conditions, work overload, administrative difficulties, organizational factors and difficulties with pupils and their relatives. They were also explored by the scale of the burnout: the Maslach Burnout Inventory (MBI), which is the best-studied measurement of burnout in the literature. We used the French version of the MBI adapted to educational settings. It is a scale composed of 22 items and three dimensions: emotional exhaustion (nine items), dehumanization (five items) and reduced personal accomplishment (eight items). In our study, we considered a teacher was suffering from burnout when at least two among the three dimensions of this scale were pathological. RESULTS: From the total number of teachers working in public high schools of Manouba (n=876), only 398 teachers filled in our questionnaires. Hence the rate of participation was 45.4%. The mean age of those participants was 40.04 years. 52.3% of them were women (sex ratio=0.91) and the great majority was married (81.8%). The burnout syndrome was found in 21% of those teachers: Moderate professional exhaustion was found in 16.4% of cases and severe professional exhaustion was found in 4.6%. A high emotional exhaustion was found in 27.4% of cases. A percentage of 16.1 of participants had a high dehumanization and 45.5% of them were susceptible to reduced personal accomplishment. The majority of teachers (66.4%) declared being stressed at work. The professional stressors reported by the teachers were in decreasing order of rate: bad working conditions (80.3%), overload work (75.2%), administrative difficulties (70.4%), difficulties with pupils and their relatives (64.4%) and finally organizational factors (57.1%). In our study, we found a strong association between burnout syndrome among teachers and three types of professional stressors which were: bad working conditions (p=0.0017), administrative difficulties (p=0.005) and difficulties with pupils and their relatives (p=0.005). The organizational factors and the work overload were not associated with the burnout syndrome. CONCLUSION: The job of teaching accumulates many difficulties. Some Tunisian teachers cannot tolerate this professional stress and develop a burnout. This syndrome leads to a teachers' psychological distress with the risk of an increase in absenteeism at work. So, we hope that this study will give rise to future research on stress, coping and burnout among Tunisian teachers, with theoretical aims as well as practical applications to prevent and reduce the risk of this problem.

[Spouses and bipolar disorder]. / Conjoints et trouble bipolaire.

OBJECTIVE: To assess the quality of life of a population of spouses of bipolar patients compared with a control population. PATIENTS AND METHODS: We conducted a cross-sectional study which included two groups: a group of 30 spouses of patients followed for bipolar I disorder according to DSM IV criteria and a second group of 30 subjects from the general population. Both groups were matched by age, sex, marital status and socioeconomic level. This device was designed to limit the differences between the two groups solely those of the bipolar illness. Evaluating the quality of life was achieved using the quality of life scale: SF-36. This is a scale that has already been translated and validated in dialect Arabic. RESULTS: Regarding sociodemographic variables, the two study groups differed only for: recreation, friendly relations and the couple relationship that included more and better skills among the control group. In the categorical approach, the quality of life was impaired in 60% of spouses and 40% of controls with a statistically significant difference. The following standardized dimensions: mental health (D4), limitation due to mental health (D5), life and relationship with others (D6) and perceived health (D8) and mental component (CM) were significantly altered in patients' spouses compared to controls. We found significant differences between the two groups for: overall average score (51.1 vs. 68.2), mental health (D4), limitation due to mental health (D5), life and relationship with others (D6), perceived health (D8) and perceived health (D8) standards. DISCUSSION: The impairment of quality of life of bipolar patients' spouses is related to the extra responsibility, stress, financial problems and health problems, stigma, and loss of security of the person loved. CONCLUSION: Considering the consequences that the appearance of bipolar disorder on the patient's spouse may have, certain measures must be proposed to improve their quality of life.

[Schizophrenia and violence, incidence and risk factors: a Tunisian sample]. / Schizophrénie et violence: incidence et facteurs de risque à propos d'une population tunisienne.

INTRODUCTION: Schizophrenia appears to be the mental pathology the most associated with violence. The aim of this study is to show the incidence and the different risk factors of violence among schizophrenics. MATERIAL AND METHOD: We have compared a group of 30 violent schizophrenic inpatients with another group of 30 nonviolent schizophrenic inpatients hospitalised during the same period. These two groups have been matched according to age and gender. The comparison concerned: sociodemographic parameters, family and personal psychiatric history, legal antecedents, social insertion, clinic, Clinical Global Impressions (CGI), Global Impairment Scale (GIS) and Positive And Negative Syndrome Scale (PANSS) scores for admissions, familial support and insight, compliance to treatment, administered treatments, and awareness degree. RESULTS: Violent schizophrenics represent 18.07% of all hospitalisations and 26.08% of schizophrenic patients. When compared to violent schizophrenic patients, nonviolent schizophrenic patients have a better socioeconomic level (77% versus 43%), better professional adaptation (67% versus 10%) and familial support (60% versus 10%), better insight (87% versus 23%) and therapeutic control (70% versus 17%). Differences are significant. We found significantly more personal antecedents of inflicted violence within violent schizophrenics (50% versus 13%), more addictive behavior (53% versus 13%), and more paranoid and indifferentiated forms (87% versus 47%) than in nonviolent schizophrenics. The average of CGI scores was significantly higher within violent schizophrenics (5.27+/-0.8 versus 3.77+/-0.5). Conversely, the average of EGF scores was lowest (37.6+/-6.5 versus 47.8+/-5.6). The comparison of PANSS scores revealed that violent schizophrenic subjects are characterised by the existence of more positive signs and more general symptoms (34.4+/-4.7 versus 20.2+/-4.5; 55.1+/-11.4 versus 46.1+/-6.9). Violent schizophrenics are characterised by higher neuroleptic doses (2375+/-738 mg/d versus 1610+/-434 mg/d). Differences here are also significant. DISCUSSION: Addictive behaviour seems to considerably increase the risk of turning to violence. Thus in our study, 53% of violent patients showed an addictive behaviour. These results have also been reported by other authors. It is obvious that alcohol and drug abuse double the risk of violence among schizophrenic subjects. Psychotic decompensation and rich symptomatology increase the violent potential among the schizophrenics. In our study, the PANSS scores were higher among violent subjects. Nonviolent schizophrenic subjects have a lesser symptomatology of psychiatric disorders and a better outcome as shown by the CGI and EGF scores. In our study, the group of violent subjects needed higher neuroleptic doses and were noncompliant. Compliance permits the acquisition, and then maintains, the stability of the mental status and plays an essential role in decreasing dangerousness. In fact, violent schizophrenics exhibit low insight, implying diminished awareness of the legal implications of their acts, and are little aware of their illness and its dangerousness. In our study, we noted better familial support among nonviolent subjects. According to the literature, violent schizophrenics are characterised by a particularly hostile and rejecting familial environment. CONCLUSION: Awareness of these factors will allow us to provide improved prevention of violence within schizophrenic subjects.

Oxidative stress and hepatotoxicity in rats induced by poisonous pufferfish (Lagocephalus lagocephalus) meat

This study was undertaken to evaluate the effect of pufferfish (Lagocephalus lagocephalus) meat poisoning on hepatic functions of Wistar rats. For this purpose, groups of rats (Lcr, Lcu+b and Lcu-b) received diet supplemented with 10 percent of raw or cooked meat, respectively, with or without cooking water of L. lagocephalus while groups Mcr and Mcu+b received diet supplemented with 10 percent of raw or cooked meat of Liza aurata, which were used as a negative control. In Lcu+b group, ALT, AST and ALP rates (hepatic enzyme markers) decreased after two months of treatment, indicating liver damage. We also observed an increase of 54 and 65 percent of thiobarbituric acid reactive substances (TBARS) in their livers respectively 48 hours and two months after treatment compared to controls. The catalase (CAT) activity in group Lcu+b decreased (p < 0.05) after two periods of treatment, whereas metallothionein (MT) level significantly increased and decreased, respectively after 48 hours and two months. In fact, in the histological analysis of the livers from Lcu+b treated group, we observed an increase in vacuolisation, necrosis, hepatocytes ballooning and sinusoids dilation. These results indicate that L. lagocephalus meat cooked with water produces hepatotoxicity and oxidative damage.(AU)

[Unipolar versus bipolar depression: clues toward predicting bipolarity disorder]. / Dépression unipolaire versus dépression bipolaire: facteurs prédictifs d'une évolution bipolaire.

Bipolar and unipolar disorders share a common depressive clinical manifestation. It is important to distinguish between these two forms of depression for several reasons. First, prescribing antidepressors in monotherapy indubitably worsens the prognosis of bipolarity disorders. Second, postponing the prescription of a mood stabilizer reduces the efficacy of the treatment and multiplies the suicidal risks by two. The object of this study is to reveal the factors that distinguish between unipolar and bipolar depression. This is a retrospective study on patients' files. It includes 186 patients divided according to DSM IV criteria into two groups: patients with bipolar disorder type I or II with a recent depressive episode (123 patients) and patients with recurrent depressive disorder (63 patients). A medical record card was filled-in for every patient. It included socio-demographic data, information about the disorder, family antecedents, CGI score (global clinical impressions), physical comorbidity, substance abuse and personality disorder. In order to sort out the categorization variables, the two groups were compared using chi2 test or Fischer's test. With regard to the quantitative variables, the two groups were compared using Krostal Wallis's test or Ancova. Our study has revealed that bipolar disorder differs significantly from unipolar disorder in the following respects: bipolar disorder is prevalent among men (sex-ratio 2) while unipolar disorder is prevailing among women (sex-ratio 0.8); patients with bipolar disorder are younger than patients with unipolar disorder (38.1 +/- 5 years vs. 49.7 +/- years); the age at the onset of bipolar disorder is earlier than that of unipolar disorder (20.8 +/- 2 years vs. 38.7 +/- 5 years); family antecedents are more important in bipolar patients than in unipolar patients (51.1% vs. 33%). More importantly, bipolar disorder differs from unipolar disorder in the following aspects: The number of suicidal attempts (25.3% vs. 23.6%); the degree of substance abuse (15.4% vs. 14.5%); the level of somatic comorbidity (20.3% vs. 17.4%); the amount of anxiety manifestations (5.6% vs. 4.8%); the extent of personality disorder (30.8% vs. 23.8%); the degree of socio-professional impairment (bachelorhood and unemployment). On the other hand, we noted that unipolar patients differ from bipolar patients in terms of the frequency of hospitalizations (3.5 vs. 3.1) and the length of stays in hospitals (25.8 vs. 20.7 days) with significant differences of 0.003 and 0.0000001 respectively. Moreover, the CGI scores of unipolar patients are higher than those of bipolar patients. However, the difference is not significant. Consequently, an early distinction between bipolar and unipolar disorder is of utmost importance for the treatment of these two illnesses.

[The evaluation of mental health among Tunisian students]. / Evaluation de la santé mentale des étudiants Tunisiens.

Universal studies are an important source of stressor. Students are at high risk for mental disorders. In this study, we seek for psychological distress among Tunisian students, using GHQ (general health questionnaire).

Isolation and structure determination of natural analogues of the mycotoxin ochratoxin A produced by Aspergillus ochraceus.

Three new natural mycotoxins, analogues of ochratoxin A, in which the phenylalanine moiety is replaced by serine, hydroxyproline or lysine, were isolated from cultures of Aspergillus ochraceus by TLC followed by HPLC column chromatography. Their structures were determined after acidic hydrolysis by the characterisation of both their amino acid moieties and of ochratoxin alpha, the chlorinated dihydroisocoumarin moiety of ochratoxin A. These structures were confirmed by mass spectrum analysis.

[Immunogenetic markers (BF, C2, C4, 21-OH, TNF alpha, TCR beta, Ig) and insulin-dependent diabetes in the Tunisian population: serological and molecular study]. / Marqueurs immuno-génétiques (BF, C2, C4, 21-OH, TNF alpha, TCR beta, Ig) et diabète insulino-dépendant dans une population tunisienne: études sérologique et moléculaire.

48 Tunisian people suffering from the IDDM auto-immune disease were compared to 35 control healthy persons for the polymorphisms of the complement BF, C2 and C4 proteins and genes, of the IgG (Gm allotypes) as well as of the TNF alpha and TCR C beta genes. Our study shows that the BFF1-C4A3-C4BQO and BFS-C4AQ0-C4B1 complotypes are associated to IDDM (RR of 2.97 and 3.07 respectively), as previously reported for other circummediterranean populations. The frequency of the Gm 21.28; 1.17; .. haplotype is increased, but not significantly, among the patients. The RFLP analysis reveals that the 2.65 kb SacI allelic restriction fragment of the C2 gene may be considered as a genetic marker of susceptibility to IDDM because its frequency raises to 0.206 among the patients vs 0.021 in the healthy individuals (p less than 0.001). The frequencies of the C4AQ0 and C4BQ0 alleles are more important among the IDDM patients than within the control sample, but the only C4BQ0 allele frequency is significantly increased. Both C4AQ0 and C4BQO result mainly from deletions. The frequencies of the allelic restriction fragments of the TNF alpha and TCRC beta genes are not significantly different among the patients and the controls. But the small sample size don't allow us to conclude definitively. It would be very interesting to extend the RFLP analysis to the TCR V beta and V alpha gene regions on more numerous samples.

[Study of the sensitivity of non-typhoid salmonellae isolated at Sfax (Tunisia)]. / Etude de la sensibilité des salmonelles non typhiques isolées à Sfax (Tunisie).

From 1982 to 1986, 122 strains of non-typhoid Salmonellae were isolated at the University Hospital of Sfax (Tunisia). Both tests: serotype classification and sensitivity have demonstrated that the most frequent serotypes: S. wien and S. typhimurium have the highest degree of multiresistance. Ampicillin, cotrimoxazole and chloramphenicol are the most affected while cefotaxime, amikacin and colistin are still saved. Facing these facts, the authors insist on the seriousness of the excessive use of antibiotherapy which leads to the selection of such strains.

The peculiar spectrum of beta-thalassemia genes in Tunisia.

We have determined the spectrum of mutations producing beta-thalassemia (beta-thal) in Tunisia by direct DNA analysis using hybridization with allele-specific oligonucleotide probes and restriction endonuclease assay. In all, 34 unrelated beta-thal patients originating from different parts of the country were available for study. The beta-globin gene cluster of each was subjected to haplotype analysis, and on the basis of this analysis, we tested each patient's DNA for one or more mutations previously shown to be linked to that haplotype. We identified four previously unreported haplotypes and found that this population differs from others in Mediterranean areas in the frequency of the beta-thal haplotypes, the unexpected observation being the high frequency of haplotype IX. Six different point mutations were found, accounting for 62% of beta-thal genes in this Tunisian population. The molecular defects known to be the most frequent in Mediterraneans (nonsense codon 39, IVS1 nt 110, IVS1 nt 6) only make up 37% of the mutant genes. One as yet undescribed mutation (IVS1 nt 2 T----G) was identified by molecular cloning and sequencing. Our results should help the implementation of a prenatal diagnosis program for beta-thal in Tunisia.

[DNA polymorphism in beta-thalassemia: a study of 15 families in Tunisia]. / Polymorphisme de l'ADN dans les beta-thalassémies: étude de 15 familles de Tunisie.

In order to perform prenatal diagnosis of beta-thalassemia by DNA analysis in Tunisia, we investigated molecular defects and their frequencies. We have determined which haplotypes are associated with beta zero or beta +-thalassemia phenotypes. Six of the haplotypes described by Orkin were observed among 15 patients homozygous for beta zero (11) or beta +-thalassemia (4). We also investigated the molecular defects. The frameshift mutation in codon 6, characterized by Mst II seems more frequent than the beta 39 non sense mutation indicating that Tunisian patients differ from other Mediterranean patients from Algeria or Italy. Results concerning beta +-thalassemia are too preliminary to draw any conclusion. The study is currently being enlarged with other molecular probes and restriction enzymes.

Correlation between alimentary mycotoxin contamination and specific diseases.

Several pathological cases including primitive hepatomas, Reye's syndrome, alimentary toxic aleukaemia, were encountered in two different Tunisian Sahel hospitals. Contamination of some nutriments of the patients by mycotoxins (aflatoxins, trichothecenes, ochratoxin A, citrinin) are most likely involved in the origin of these diseases.

Gm, Am and Km immunoglobulin allotypes of two populations in Tunisia.

Gm, Am and Km allotypes were investigated in two Tunisian populations (236 samples from Mahdia and 142 samples from Sfax). These populations descend from immigrants and, therefore, the results were compared with those obtained in other populations living in the Near East and in North Africa. The subclass heavy chain allotypes G1m, G2m, G3m and A2m are inherited in fixed combinations. There were five main and four minor Gm-Am haplotypes that could be deduced from the phenotypes. This led to the conclusion that the populations studied are Caucasoids with some African admixture (about 10%) and a very low oriental contribution. Furthermore, there were 11 samples which showed 8 uncommon Gm-Am phenotypes. These could be explained by the assumption of five different uncommon Gm-Am haplotypes. Four of these may have arisen by equal crossing over of prevalent haplotypes. The fifth may be the result of unequal crossing over of prevalent haplotypes. The fifth may be the result of unequal crossing over, since it was proven, by family study, that more markers are transmitted together than are present in the prevalent haplotypes.