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The papers in this special section examine the use of predictive intelligence for bioinformatics. Big data is fueling diverse research directions in both medical image analysis and computer vision research fields. These can be divided into two main categories: (1) analytical methods, and (2) predictive methods. While analytical methods aim to efficiently analyze, represent, and interpret data, predictive methods leverage the data currently available to predict observations at present (e.g., by completingmissing observations), at previous time-points (e.g., by solving reverse problems), or at later time-points (i.e., forecasting the future). For instance, a method which only focuses on classifying patients with mild cognitive impairment (MCI) and patients with Alzheimer’s disease (AD) is an analytical method, while a method that predicts if a subject diagnosed with MCI will remain stable or convert to AD over time is a predictive method. Similar cases can be established for various neurodegenerative or neuropsychiatric disorders, degenerative arthritis, or cancer studies, in which the disease/disorder develops over time.

Objectives Granulosa cell tumor of the ovary (GCT) is a rare ovarian malignancy. The natural history of GCT is one of slow growth, with a tendency for late recurrence. However, in some cases it appears to be more aggressive. Our Aim is to identify prognostic factors for a better patient selection for adjuvant treatment. Methods It’s a retrospective study about patients GCTs treated in our institution between january1993 to December 2014. Overall survival and disease free survival were defined according to NCI Dictionary of Cancer Terms. Results A total of 59 women were included in this study. The median age was 55 year old (IQR 44–63). The mean tumor size was 14,92 ±7cm. 75,9% (n=35) were FIGO stage I. All our patients have been initially treated with surgery and the median follow up after surgery was 44 months (IQR 14–88). The overall survival (OS) at 5 and 10 years was respectively 92% and 82%. The disease free survival (DFS) at 5 and 10 years was 76,9% and 31,9%, respectively. In multivariate analysis, FIGO stage [aHR(95%CI): 3.67(1.1–11.9), P=0.03] and residual tumor [aHR(95%CI): 3.74(1.48–9.44) p=0.005] were independent risk factors for all-cause mortality. Similarly, after adjusting for potential confounders, FIGO stage was associated with a 70% decrease in DFS [aHR(95%CI): 1.77(1.04–3.01), P=0.034] whereas age increased DFS by 5% [aHR(95%CI): 0.95(0.91–0.98), P=0.012] Conclusions In our study, we found non-modifiable prognostic factors that may help indicate adjuvant chemotherapy. Further studies in larger population, with longer follow-up to determine a clear threshold for adjuvant chemotherapy are warranted.

The mixtures of Ni, Al, and Ti elemental powders with nominal compositions Ni-30 at.% Al-10 at.% Ti were mechanically alloyed in a planetary ball mill under argon atmosphere. The structural and morphological changes during high-energy mechanical alloying were investigated by X-ray diffraction and scanning electron microscopy. We have found differences in the kinetics of solid-state reactions which depend on the differences in the individual properties. The final products of the mechanical alloying process were nanocrystalline nickel-rich solid solutions with a mean crystallite sizes in the range of a few nanometers. As a result, the prolonged milling time allows the disordered Ni3(Al,Ti) solid solution to dissociate to the L20-Ni(Al,Ti) phase and L12-Ni3(Al,Ti) phase. Further, it was found that the formation of L20-Ni(Al,Ti) phase was favored when considering the total reaction of the finite quantities of Al and Ti in the presence of an excess of Ni. Calorimetric studies demonstrate the coexistence of overlapping exothermic peaks characteristic of crystallization processes associated with the identified phases.

The present study reports on the analysis of the microstructure, martensitic transformation, and thermomagnetic response of a Ni50Mn37Sn6.5In6.5 Heusler alloy produced by melt spinning. Columnar grains and preferential orientation have been obtained. The As-spun alloy displayed a single phase (L2(1) cubic austenite) structure at room temperature. The structural austenite-martensite transformation was checked by calorimetry. The magnetic change due to the martensitic transformation induced by high magnetic fields of up to 30 kOe was investigated. The martensitic transformation temperatures were noted to decrease with the increase of magnetic field This study was supported by financial funds from the MAT2013-47231-C2-2-P project. The authors would like to express their gratitude to Xavier Fontrodona Gubau for her XRD support

Alloimmunization against high-frequency erythrocyte antigens is a problematic situation in terms of laboratory diagnosis, transfusion and obstetrical management. We report the case of a pregnant woman alloimmunized against public Ag. We detail the difficulties of alloantibody (Ab) identification and transfusion management of the deliveries. A 29-year-old pregnant woman was hospitalized in gynecology and obstetrics departments at 36 weeks of gestation for assessment of hydrops fetalis. Antibody identification test revealed the presence of a pan-reactive antibody. Investigations realized in CNRGS (Paris) concluded in anti-GE2+anti-RH3+autoantibody. The red cell phenotype was GE: -2,3. A therapeutic interruption of the pregnancy was indicated. A program of autologous transfusion was organized with withdrawal of 2 units of blood. The 2nd pregnancy took place normally. Before delivery, an autologous blood reserve consisting of 2 red cell packs and 2 fresh frozen plasma was withdrawn and transfused after delivery. The management of anti-public alloimmunization poses several problems. The first one is of diagnostic nature with, on the one hand, the difficulty of Ab identification by the available red cell panels and, on the other hand, the possible presence of alloantibodies of transfusional or obstetric interest masked by anti-public Ab. The second is represented by transfusional care of these patients. In the absence of a national reserve of frozen rare blood, the autologous transfusion remains the only alternative. However, it can answer only a limited number of indications and only in case of moderate blood loss.

Ferromagnetic shape memory alloys are characterized by both the structural austenite to martensite transformation and also by the magnetic transition from ferromagnetic to paramagnetic. The set of properties makes them candidates for use in several applications such as sensors, actuators, or magnetic refrigeration systems. Among the Heusler-type alloys that exhibit this behavior, the most studied system is the Ni–Mn–Ga. However, to overcome the high cost of Gallium and the generally low martensitic transformation temperature, the search for Ga-free alloys has been recently attempted, particularly, by introducing Sn. The martensitic transformation and the solidification structures of Mn 50 Ni 50−x Sn x (x = 7, 8.7 and 10.5) ribbons prepared by melt-spinning were investigated by means of scanning electron microscopy, X-ray diffraction, and differential scanning calorimetry. While the As-spun alloys Mn 50 Ni 43 Sn 7 and Mn 50 Ni 41.3 Sn 8.7 displayed a single-phase (14-M monoclinic martensite) structure at room temperature, the As-spun and Mn 50 Ni 39.5 Sn 10.5 displayed a single-phase cubic Heusler L2 1 . The martensitic transformation temperatures were noted to decrease with the increase of Sn concentration This study was supported by financial funds from the MAT2013-47231-C2-2-P projec

The effect of In and Co additions on the structure and thermal properties of melt-spun process Ni–Mn–Sn alloys has experimentally investigated at a solidification rate of ~48 m s−1. The present study reports on the analysis of the microstructure, martensitic transformation of Ni50Mn42.5Sn7.5, Ni50Mn37.5Sn7.5Co5 and Ni50Mn37Sn6.5In6.5. Heusler alloys produced by melt spinning. The crystal structures of the fabricated alloys were determined by means of X-ray diffraction. While the as-spun alloy Ni50Mn42.5Sn7.5 displayed a single-phase (14M monoclinic martensite) structure at room temperature, the as-spun Ni50Mn37.5Sn7.5Co5 displayed a main martensitic phase of a four-layered orthorhombic (4O) structure and the as-spun Ni50Mn37Sn6.5In6.5 displayed a single-phase cubic Heusler L21. The characteristic transformation temperatures and the thermodynamic parameters of the samples were determined by differential scanning calorimetry measurements. This study investigated the effect of the substitution of Co by Mn in Ni50Mn42.5−xSn7.5Cox. The martensitic transformation temperatures, enthalpy and entropy changes were found to increase progressively with doping Co content and the effect of the substitution of In by Mn. The martensitic transformation temperatures, enthalpy and entropy changes were found to decrease progressively with doping In This study was supported by financial funds from the MAT2013-47231-C2-2-P project

Resume Objectif Evaluer les taux d’immunisation anti-erythrocytaire dans les hemoglobinopathies. Patients et methodes Etude prospective (1990–2009) portant sur 84 patients : 44 drepanocytaires homozygotes, un drepanocytaire heterozygote S/C, 30 thalassemiques et neuf drepano-thalassemiques. L’âge moyen a ete de 10,13 ans (extremes : 1–45). Les concentres de globules rouges ont ete ABORH1 compatibles au debut puis phenotypes RH-KEL a partir de 2006 et phenotypes RH-KEL et dans les autres systemes apres immunisation. Les concentres de globules rouges ont ete compatibilises en test de Coombs indirect. La recherche d’agglutinines irregulieres a ete realisee avant chaque episode transfusionnel et le test de Coombs direct lorsque l’indication s’imposait. Resultats Le nombre de concentres de globules rouges transfuses a ete de 3545 (42,2/patient). Le nombre des recherches d’agglutinines irregulieres et des tests de Coombs direct ont ete, respectivement, de 1474 (17,5/patient) et de 272 (3,2/patient). Nous avons identifie 27 anticorps (32,1 %) : 14 allo-anticorps, soit 16,6 % (16,6 % chez les drepanocytaires, 16,6 % chez les thalassemiques, p = 1), 16 auto-anticorps, soit 19,04 % (11,1 % chez les drepanocytaires, 33,3 % chez les thalassemiques, p = 0,018) dont trois cas d’association auto- et allo-anticorps. Les allo-anticorps ont ete essentiellement de specificite anti-RH secondaires a la transfusion de concentres de globules rouges standard. Il n’existait pas de relation significative entre le sexe et l’immunisation, ni entre la consommation de concentres de globules rouges et l’allo-immunisation. En revanche, il existait une relation significative entre auto-immunisation et consommation de concentres de globules rouges chez les thalassemiques (p Conclusion Cette etude confirme l’interet de systematiser la transfusion de concentres de globules rouges RH KELL compatible chez les hemoglobinopathes polytransfuses afin de reduire le taux d’allo-immunisation aux antigenes erythrocytaires les plus immunogenes.

Polymer composites of a polyester resin matrix with randomly dispersed Alfa fibers were prepared and their dielectric spectra were measured in the frequency range 0.1 Hz–0.1 MHz and temperature interval from ambient to 180 °C. Cellulose fibers were incorporated into the matrix, as such or after surface modification involving three silane coupling agents, namely γ-methacryloxypropyltrimethoxy (MPS), hexadecyltrimethoxy-silanes (HDS), γ-mercaptoproyltrimethoxy-silane (MRPS).

The dynamic dielectrical analysis of short palm tree lignocellulosic fiber-reinforced polyester composites was carried out with special reference to the effect of fiber orientation, frequency, and temperature. Measurements were performed in the temperature range 40—200°C and in the frequency range 1—100 kHz. Three relaxations processes were identified, namely the orientation polarization imputed to the presence of polar water molecules in palm fiber, the relaxation process associated with conductivity occurring as a result of the carriers charges diffusion noted for high temperature above glass transition and low frequencies, and the interfacial or Maxwell—Wagner—Sillars relaxation that is attributable to the accumulation of charges at the palm fibers/polyester interfaces. The orientation of the fiber can strongly influence the dielectrical properties and interfacial polarization processes in composites.

Polymer composites of a polyester resin matrix filled with short palm tree lignocellulosic fibers were studies by means of dielectric spectroscopy in the frequency range 0, 1–100 kHz and temperature interval from 40 °C to 200 °C. Three relaxations processes were identified, namely the orientation polarization imputed to the presence of polar water molecules in Palm fiber, the relaxation process associated with conductivity occurring as a result of the carriers charges diffusion noted for high temperature above glass transition and low frequencies, and the interfacial relaxation that is attributable to the accumulation of charges at the Palm fibers/polyester interfaces.

Resume Introduction Les immunosuppresseurs sont habituellement indiques dans le traitement de premiere ligne des formes non severes de l’aplasie medullaire acquise (AMA). Le but de ce travail etait d’evaluer l’efficacite d’un protocole prospectif associant la ciclosporine aux androgenes dans le traitement des AMA non severes de l’adulte. Methodes Vingt-neuf cas diagnostiques et suivis a Sfax ont ete inclus sur une periode de dix ans (1991–2000). Mis a part le traitement symptomatique, tous nos patients ont recu un traitement specifique comportant une bitherapie a base de ciclosporine a la dose de 5 mg/kg par jour et des androgenes a la dose de 0,5 mg/kg par jour. Resultats Les taux de reponses a trois mois, a six mois et a 12 mois sont respectivement de 48, 75 et 87 %. Les taux de survies sont de 52 % a un an et de 37 % a cinq et dix ans. Les principales toxicites etaient hepatiques et renales ainsi que l’hypertension arterielle, qui ont ete observees chez respectivement 53, 16 et 15 % des patients avec une reversibilite respective dans 65, 87 et 100 % des cas. Conclusion Les taux de reponse et de survie dans notre serie sont assez satisfaisants comparativement a ceux obtenus par les immunosuppresseurs (serum antilymphocytaire et ciclosporine) dans la litterature. L’association des androgenes a permis de potentialiser l’immunosuppression induite par la ciclosporine mais au prix d’effets secondaires plus importants.

Fe68.45Pd28.21Co1.66Ni1.66 alloy in ribbon geometry was produced by melt spinning. The microstructure of the samples was examined using scanning electron microscopy. The structural identification of the as-spun ribbon sample and the annealed ones was performed by means of X-ray diffraction. All the Bragg peaks were indexed based on an fcc type structure of (¿-Fe, Pd) phase with a lattice parameter a = 3.742 (3) Å. This result was proved by Mössbauer technique. The annealed ribbon at 600 °C shows an L1_0 ordered fct structure. An endothermic reaction at T = 358 °C followed by an exothermic one at 390 °C were observed on heating. These reactions were attributed to the Curie temperature of nickel and to the annihilation of an excess of quenched-in vacancies, respectively.

Les dons issus de donneurs de sang (DDS) volontaires sont connus pour etre plus securitaires (disponibilite du sang et risque infectieux). La majorite des DDS au CRTS de Sfax (Tunisie) sont des DDS de compensation (87 %), certains deviennent des donneurs reguliers. Notre but etait d’etudier la motivation des DDS de compensation reguliers et les facteurs susceptibles de les reconvertir en DDS volontaires. Il s’agit d’une etude descriptive basee sur un questionnaire elabore dans le dialecte local et administre par deux etudiants infirmier dans le cadre de leur PFE chez les DDS ayant donne ≥ 3 reprises au CRTS de Sfax durant les mois de fevrier et mars 2016. Le questionnaire etait fait de 3 parties (motivation, intention et fidelisation au don). Parmi 5840 DDS, 103 etaient des DDS de compensation reguliers. Parmi ces derniers, 96 % etaient des hommes, la majorite (44 %) avaient entre 30 et 40 ans, un niveau d’etudes secondaires (46 %), plus de 5 dons (45 %) pour des amis, des collegues et leur famille (60 %). Soixante-sept pour cent ont exprime une intention au don volontaire. Un accueil plus convivial, la reduction du temps d’attente et une collecte de proximite ont ete evoques par respectivement 74 %, 68 % et 52 % des DDS comme moyen incitant a la fidelisation. La publicite televisee etait le moyen publicitaire prefere (40 %) alors que les appels telephoniques etaient le moyen de convocation prefere (70 %). L’OMS recommande de reconvertir les DDS de compensation en volontaires. Cet objectif est plus facile a atteindre en connaissant la motivation et les preferences de ces DDS en l’occurrence, chez nos DDS, une attente d’approche qui reste classique (television et telephone).

Alloimmunization against high-frequency erythrocyte antigens is a problematic situation in terms of laboratory diagnosis, transfusion and obstetrical management. We report the case of a pregnant woman alloimmunized against public Ag. We detail the difficulties of alloantibody (Ab) identification and transfusion management of the deliveries. A 29-year-old pregnant woman was hospitalized in gynecology and obstetrics departments at 36 weeks of gestation for assessment of hydrops fetalis. Antibody identification test revealed the presence of a pan-reactive antibody. Investigations realized in CNRGS (Paris) concluded in anti-GE2+anti-RH3+autoantibody. The red cell phenotype was GE: -2,3. A therapeutic interruption of the pregnancy was indicated. A program of autologous transfusion was organized with withdrawal of 2 units of blood. The 2nd pregnancy took place normally. Before delivery, an autologous blood reserve consisting of 2 red cell packs and 2 fresh frozen plasma was withdrawn and transfused after delivery. The management of anti-public alloimmunization poses several problems. The first one is of diagnostic nature with, on the one hand, the difficulty of Ab identification by the available red cell panels and, on the other hand, the possible presence of alloantibodies of transfusional or obstetric interest masked by anti-public Ab. The second is represented by transfusional care of these patients. In the absence of a national reserve of frozen rare blood, the autologous transfusion remains the only alternative. However, it can answer only a limited number of indications and only in case of moderate blood loss.

The aims of this study is to determine the hemogram reference values in a population of healthy adults of the region of Sfax, to compare our results with those from the literature, to estimate the age and sex variations in the blood count. The hemogram parameters were analyzed in 1000 blood donors. Hemogram was performed using Coulter ACT10's analyser. The differential leukocyte count was manually performed. The means of erythrocyte count, hemoglobin, haematocrit and red cell indices were significantly lower in women than in men. There was a significant variation in the red blood cell count, hemoglobin and haematocrit with age. There is also sex and age differences of the leukocyte count. The neutrophil and eiosinophil counts were higher in women than in men. The lymphocytes decreased with age in both sexes. The platelet count was significantly higher in women than in men. These results can be applied only to our local population of adults. The definition of reference values for the Tunisian population requires a study on a more diversified population, including more important number of individuals from various regions of the country.

But Decrire les resultats et la tolerance des echanges plasmatiques (EP) dans la myasthenie. Sur une periode de 18 ans (1997–2014), nous avons echange 32 patients atteints de myasthenie d’âge moyen 39 ans (10 a 76) et de sexe ratio 0,8. Le delai moyen avant EP etait de 54 mois (1 mois a 20 ans). Le score d’Oussermann etait evalue apres chaque seance. Les EP ont ete effectues sur separateur a flux discontinu (PCS+ ou MCS3P) puis continu (Cobe Spectra). Un total de 161 seances reparties en 41 series [moyenne 4 seances/serie ; extremes 1 a 7] ont ete effectuees. Vingt-cinq patients (78,1 %) ont beneficie d’une serie et 7 patients (21,9 %) de 2 a 3 series espacees de 3 mois a 6 ans. Le volume epure moyen/seance etait de 3 L (0,2–4,4 L). La duree moyenne des EP etait de 112 min (20–210 min) ; significativement plus courte sur separateur a flux continu que discontinu (104 min vs 162 min ; p p = 0,001). L’evolution a ete marquee par une amelioration significative du score d’Oussermann ( p Les EP ont une indication de categorie 1, grade 1 dans les myasthenies moderees a severes et en preoperatoire. Le separateur a flux continu, le seul utilise actuellement dans notre centre, assure une meilleure tolerance et une duree plus courte.

In Tunisia, blood donation is voluntary, anonymous and non-remunerated. The aim of the study is to analyze donor motivation and sociology in the regional center of transfusion of Sfax. Between 14 May 2007 and 23 June 2007, a total of 903 Tunisian blood donors filled a questionnaire. Among the donors, 81.8% were men and have a mean age of 34.2 years and the majority of them have an age between 18 and 29 years. The middle social class was majority (77.8%) as well as the liberal profession (65.1%). Primary and secondary education were dominant (79.3%). Among the blood donors, 41.6% were new donors and 28.6% had a history of a single donation, 50.3% were voluntary and 49.7% replacement donors. The reasons motivating the voluntary donation were solidarity (69.9%), religion (21.2%), health benefit (3.6%) and insurance for the family (5.2%). The replacement donors refuse the voluntary donation for not obvious reasons (51%), lack of availability (13.3%), difficulties of accessibility of the sites of collection (7.6%), phobia of the blood and the stings (4.02%) or by refusal of blood donation (1.79%). The information and the raising awareness of the replacement donors could change in a near future their attitudes to become voluntary and regular donors. The implication of donor associations in the organization of the collections and the promotion of the blood donation would be of considerable contribution.

To estimate the rate of red cell immunization in hemoglobinopathies.Prospective study (1990-2009) about 84 patients: 44 homozygous sickle cell anemia, one heterozygous sickle cell anemia S/C, 30 thalassemia and nine sickle cell anemia-thalassemia. The mean age was 10.13 years (extremes: 1-45). The red cell units transfused were ABORH1 compatible, then RH-KELL phenotyped after 2006 and phenocompatible after alloimmunisation. The cross-match was realized using indirect antiglobuline test. Irregular red cell antibody screening was realized before every transfusional episode and the direct antiglobuline test was done when there was a poor transfusional efficiency.The number of red blood cells units transfused was 3545 (42.2/patient). The number of red cell antibody screening and the number of direct antiglobulin test were respectively 1474 (17.5/patient) and 272 (3.2/patient). Twenty-seven antibodies were identified (32.1%): 14 alloantibodies (16.6%, 16.6% in sickle cell disease, 16.6% in thalassemia, P=1), 16 antoantibodies (19.04%, 11.1% in sickle cell disease, 33.3% in thalassemia, P=0.018). There were three cases of association of allo- and autoantibodies. The most frequent alloantibodies were anti-RH3 and anti-KEL1 and were developed after transfusion of standard red cell units. There was no significant relation, neither between sex and risk of immunization, nor between the number of red cell units transfused and alloimmunization. On the other hand, there was a significant relation between autoimmunization and the number of red cell units transfused in thalassemia (P0.001).This study proves the interest of using RH-KELL red cell units compatible in patients with hemoglobinopathies in order to reduce alloimmunisation rates.

Varicella is a cosmopolitan communicable disease caused by varicella-zoster virus (VZV) characterized by papulovesicular rash and fever. Management of fever and pruritus and prevention of bacterial infection are the main aspects of treatment. Severe complications and death may occur in pregnancy, in newborns, in adults, and in immunocompromised children. Contrary to immunocompetent adults in whom pneumonia occurs in 50% of cases during varicella, this complication in children is rare. We report a fatal case of pneumonia with severe hypoxemia during varicella in an immunocompetent 16-month-old child. Based on a literature review, we discuss the main aspects of diagnosis, treatment, and prognosis of varicella. Active immunization of children after 12 months of age is the primary prevention of varicella.

To evaluate the prevalence of alloimmunization in women followed in an obstetrical environment in Tunisia, to identify the specificities of antibodies found and to determine factors that could influence the appearance of this immunization.We proceeded to a retrospective analysis of search for irregular antibodies in women followed up in obstetrical environment over nine consecutive years (2000-2008). The panel was officially defined and produced by the Regional Centre for Blood Transfusion in Sfax (Tunisia).Overall 5369 women benefited from 6575 antibody testing (average: 1.22; extremes: 1-14). The results were positive for 278 women (5.17 %), allowing to identify 216 antibodies or associations of antibodies. Among identified antibodies, those immune were found in 198 women. The rate of alloimmunization was 3.68 % (198/5369). The majority of the antibodies found was anti-Rh1, isolated or associated with another antibody, in 84.3 % of the total immunized women. The immunization of women according to the number of gestations showed a significant increasing rate ranging from 2.34 % for a first gestation to 5.27 % for four gestations or more. In addition, a significant difference was also noted between the rate of immunization in women who had received anti-Rh1 immunoglobulin and those who had not.Anti-Rh1 immunization is the most frequent in the population of studied women. This could denote of an insufficiency in pregnancies follow-up and immunoprophylaxis protocols.

The aim of the study was to assess hepatitis A virus (HAV) seroprevalence in blood donors from South Tunisia in two periods 2000 and 2007. Serum samples collected from 376 blood donors in each period aged 18 to 30 years from different regions of South Tunisia were analysed for anti-HAV IgG. The global seroprevalence of HAV infection was 85.9% in 2007 as compared with 94.9% in 2000. The seroprevalence in the 18-20 years age group was 91.9% in 2000 vs 80.6% in 2007, and increased to 99% in 2000 and 92% in 2007 in the subjects over 26. Taking account of geographic area, the HAV seroprevalence in Sfax city decreased from 88.9% in 2000 to 62.7% in 2007 (p0.001), but it is still approximatively the same in rural areas (98.4% and 96%) and in the governorates of South Tunisia (97.6% and 99.2%). In conclusion, the number of adults in the city of Sfax which are not immunized against HAV is increasing. Thus, adolescents and young adults are at risk to develop symptomatic and potentially severe hepatitis A.

Immunosuppressive drugs are usually used in the treatment of acquired aplastic anemia (AAA). The aim of this study was to evaluate the efficiency of a prospective therapeutic protocol using cyclosporine and androgens in the treatment of adult patients with nonsevere AAA.Twenty-nine patients diagnosed and treated at the University Hospital of Sfax (Tunisia), during a 10-year period (1991-2000) were included. In addition to symptomatic treatment (transfusion, antibiotics), all the patients received a specific treatment including two drugs: cyclosporine 5mg/kg per day and androgens 0,5mg/kg per day.The response rate at three, six and 12 months were 48, 75, and 87%, respectively. Survival rate was 52% at one year, and 37% at five and 10 years. The main toxicities were hepatic, renal, and hypertension, observed in 53, 16 and 15%, respectively. These toxicities were reversible in 65, 87 and 100% of the cases, respectively.The response and survival rates in our series are quite satisfactory when compared to those obtained with other immunosuppressive drugs (cyclosporine and antilymphocyte serum) in the literature. The addition of androgens in our patients seemed to potentiate the immunosuppression induced by ciclosporin, but secondary toxic effects were more common.

Malgre l’augmentation de production et la rationalisation de l’utilisation, la gestion des concentres plaquettaires (CP) reste difficile, surtout pour un CHU multidisciplinaire qui accueille tous les cas compliques du sud du pays. But Evaluer le degre de satisfaction des demandes de CP au CRTS de Sfax (Tunisie). Sur une periode de 6 ans (2009–2014), les demandes de CP recues ont ete classees, de facon prospective, selon leur degre de satisfaction : demandes honorees en totalite (DHT), partiellement honorees (DPH) et non honorees (DNH). Un total de 15 971 demandes de CP a ete recu [mediane = 7 ; ET = 3,36] avec une augmentation significative des demandes [1927 en 2009 a 3488 en 2014 (p

Le phenotype rare RH:1,-2,-3,-4,-5 (D- -) est caracterise par la disparition des antigenes (Ag) Rhesus de grande frequence et impose des precautions en cas de transfusion et/ou de grossesse. Nous rapportons le cas d’un phenotype RH:1,-2,-3,-4,-5 decouvert lors d’un bilan pretransfusionnel. Une transfusion de globules rouges (CGR) a ete indiquee chez une patiente lybienne (51 ans, race noire) pour hemorragie digestive. Le groupage sanguin (GS) a ete O RH 1. Le phenotype RH-KEL1, realise en microplaque et en gel-filtration par 2 reactifs differents (Biorad, Diagast), a ete negatif pour les 5 Ag. L’epreuve de fixation-elution (2 reactifs differents) a ete negative avec l’anti-C et l’anti-c, positive faible avec l’anti-e et positive avec aspect de double population avec l’anti-E BioRad et negative avec l’anti-E Diagast. La recherche des anticorps irreguliers (RAI) et le test direct a l’antiglobuline (TDA) ont ete negatifs. L’etude familiale a objective le phenotype D- - chez le frere qui etait de groupe AB+. En l’absence d’un donneur familial compatible, d’une reserve de sang rare cryopreserve et devant l’urgence vitale, la patiente a ete transfusee par 1 CGR O RH:1,-2,-3,4,5 et KEL:-1. Une RAI, realisee 2 ans plus tard, a objective une pan-agglutination (panel DiaMED) avec un TDA negatif. Une allo-immunisation anti-public a ete suspectee et un prelevement adresse au CNRGS. La prise en charge d’un patient ayant un phenotype erythrocytaire rare pose des problemes diagnostiques et transfusionnels. En l’absence d’une reserve nationale de sang rare congele, la transfusion autologue constitue la seule solution. Cependant, elle ne peut repondre qu’a un nombre limite d’indications.

L’hemorragie obstetricale est une cause majeure et evitable de mortalite. Nous decrivons les pratiques transfusionnelles des services d’obstetriques s’approvisionnant au CRTS de Sfax. Etude prospective de 317 demandes de sang concernant 194 patientes. L’âge median etait de 33 ans (ET = 6). Le nombre median de demandes/patiente etait de 2 (ET 1). Les totaux, medianes et ET respectifs des CGR, PFC et CP delivres etaient de : 757, 4 et 2,8 ; 891, 6 et 6,1 ; 435, 10 et 6. Les PSL demandes en « reserve » et non utilises etaient de 55 CGR, 179 PFC et 142 CP. Soixante-dix patientes (36 %) etaient Rh neg. Des CGR isogroupes isoRh phenotypes et compatibilises en Coombs indirect ont ete distribues sauf pour 2 cas (1 non isoRh et 1 non phenotype). Cinq demandes ont ete honorees sans test de compatibilite et 2 autres avec test salin. Nom, prenom et date de naissance des patientes etaient notes sur 100 % des demandes ; le n o du lit, le matricule et le n o du dossier l’etaient respectivement sur 87 (27,5 %), 259 (81,7 %), 85 (26,8 %) demandes. Le nom prenom et le n o de telephone du medecin prescripteur l’etaient respectivement sur 277 (87,4 %) et 128 (40,4 %) demandes et le taux d’hemoglobine sur 107 demandes (33,8 %) [mediane 6,6 g/dL ; ET 1,6]. Sur les 311 demandes horo-datees, 150 (48,2 %) etaient de nuit. L’urgence etait signalee sur 66 demandes (20,8 %) [urgent : 48 (72,7 %), tres urgent : 10 (15,2 %) et autres : 8 (12 %)]. Le deces a ete note dans 3 cas (1,5 %) et du a un retard d’admission. Si les produits sanguins sont disponibles, d’autres elements de la securite transfusionnelle meritent plus d’attention meme s’ils ne sont pas en cause des deces constates.

Pilier de l’hemovigilance, le suivi serologique des polytransfuses permet l’evaluation des complications post-transfusionnelles, en particulier infectieuses. Notre etude, prospective (1991–2014), a concerne 131 patients atteints de troubles hemorragiques constitutionnels : 75 hemophiles, 16 maladies de Willebrand, 20 deficits en facteur (F) XIII, 11 en F VII, 6 en F XI, 2 en F V et 1 en F VII + IX, transfuses par des produits sanguins labiles (PSL). Le depistage de l’Ag HBs, des Ac anti-VIH puis de l’Ag-Ac et des Ac anti-VHC puis de l’Ag-Ac a ete realise tous les 6 mois par technique Elisa. La confirmation VHC et VIH a ete faite par immuno-blot. Les patients etudies ont recu un total de 47 490 PSL (46 979 plasmatiques [moyenne 356,6] et 511 cellulaires [moyenne 3,9]). A l’inclusion, 20 patients (15,3 %) avaient une serologie positive VHC dont 12 transfuses avant 1994 (annee de debut du depistage), 4 patients VHB et 1 VIH imputee a des PS importes (0,8 %). Au cours du suivi, nous avons note une seroconversion VHB (0,8 %) et 17 VHC (13 %). Il n’existe pas de relation significative entre le nombre de PSL recus et le taux de seroconversion pour les marqueurs etudies. Les taux de seroconversion ont diminue significativement a partir de 2000 (diminution du RR de transmission virale de 1,7/1000 PSL entre 1995–2000 a 0,5/1000 PSL entre 2000–2014). La seroconversion, quoique non nulle, a ete decroissante au fil des annees pour s’annuler depuis 2010. Ceci est lie a une amelioration des conditions sanitaires, une meilleure selection pre-don, une plus grande sensibilite des coffrets de depistage et la vaccination systematique VHB depuis 1995.

Le deficit immunitaire commun variable (DICV), le plus frequent des deficits immunitaires primitifs de l’adulte, est caracterise par une hypogammaglobulinemie secondaire a des troubles de maturation des lymphocytes B. Nous rapportons le cas d’un DICV diagnostique devant une difficulte de groupage sanguin (GS) ABO. Une femme âgee de 32 ans est suivie au service d’Hematologie pour exploration d’une pancytopenie, d’adenopathies cervicales et d’une splenomegalie. Le bilan etiologique n’a pas ete concluant (myelogramme et biopsie osteomedullaire normales), d’ou l’indication d’une splenectomie a visee diagnostique. Le GS ABO, realise sur deux echantillons differents, a objective une agglutination avec les serums-tests anti-A et anti-A + B dans l’epreuve globulaire et l’absence d’agglutination dans l’epreuve serique. Les temoins auto, allo et AB etaient negatifs. L’immunoelectrophorese des protides seriques a montre une baisse des 3 classes d’immunoglobulines (IgG = 5,89 g/L, IgA L’absence des Ac naturels et reguliers mise en evidence par l’epreuve serique de Simonin doit amener a pousser les explorations a la recherche d’un deficit immunitaire surtout dans un contexte evocateur.

Dans le syndrome de Guillain-Barre (SGB), les echanges plasmatiques(EP) ont une indication de categorie 1, grade 1 A. Chez l’enfant, une reticence est notee face a ce traitement. But Comparer, entre enfants et adultes, les resultats et la tolerance des EP. Sur une periode de 18 ans (1997–2014), 184 patients ont ete echanges, dont 38 (20,6 %) enfants (2–14 ans). Les EP etaient effectues sur PCS+, MCS3P puis Cobe Spectra et suivis sur fiches dediees. Le total des seances etait de 675 (enfant 144 ; adulte 531). Chez l’enfant et chez l’adulte, les moyennes des seances, des volumes epures/patient et des delais evolutifs avant EP, etaient respectivement de 3,7 (1 a 6) vs 3,6 (1 a 7) seances/patient (p = 0,5) ; 1,5 L (0,3–3,4 L) vs 3,4 L (0,4–5,6 L) et 9,7 jours (5 a 45) vs 11,5 jours (3 a 60) (p = 0,1). Une amelioration significative du score fonctionnel etait notee (p Outre les problemes d’abord, la tolerance des EP est equivalente chez l’enfant et l’adulte avec une extubation qui semble etre plus precoce chez l’enfant.

Depuis 1990, le CRTS de Sfax a mis en place un systeme d’hemovigilance receveur, puis l’a etendu aux donneurs de sang (DDS) meme en l’absence d’obligation reglementaire. Le suivi de la prevalence et de l’incidence de l’Ag HBs permettent, non seulement d’evaluer le risque residuel (RR) de transmission du virus par transfusion, mais aussi la selection des DDS. Notre etude a porte sur 196 476 DDS entre janvier 2008 et decembre 2014. Le depistage de l’Ag HBs a ete effectue par test Elisa, successivement de 3e et 4e generations (Monolisa Ag HBs, Ag HBs plus et Ag HBs ultra [Biorad]). La prevalence globale de l’Ag HBs a ete de 1,9 % (3,23 % en 2008 a 1,08 % en 2014). Trois cent soixante-dix-huit DDS ont beneficie d’un controle de l’Ag HBs a l’occasion d’un nouveau don ou apres convocation. Une seule seroconversion Ag HBs a ete depistee en 2010 chez un DDS volontaire 12 mois apres son dernier don et confirmee 15 jours apres. Le taux d’incidence et le risque relatif a ete calcule sur 2 periodes de 3 ans. Ainsi l’incidence de l’Ag HBs 2008–2010 a ete de 0,7 pour 100 000 PA et le RR de transmission de cet Ag a ete de 1,12 par 1 000 000 de dons. Chez les DDS tunisiens, la prevalence de l’Ag HBs est moyenne. La diminution de la prevalence, au fil des annees, reflete l’amelioration des conditions sanitaires du pays. Le calcul du taux d’incidence ainsi que du RR restent, toutefois, sous-estimes vu que les donneurs ayant beneficie d’un controle serologique constituent une minorite de DDS.

Detection of anti-CMV antibodies was carried out in sera of healthy blood donors, divided into groups of 20 according to age and sex. Sera were tested for anti-CMV by an ELISA test (Enzygnost anti-CMV/IgG-Behring). Among 280 sera, 272 were positive for IgG to CMV (97.14%). The prevalence of those antibodies was high in all age stratum (95-100%) but was higher in women than in men (98.57% versus 95.71%). The titre of IgG to CMV was superior to 12 Ul/ml in 56.43% of CMV positive donors. So, the leucocyte removal is the only alternative for the prevention of post-transfusional CMV infection. The high percentage of donors with anti-CMV antibodies level more than to 12 Ul/ml allow to consider the use of plasmapheresis for preparing specific immunoglobulins to CMV.

A case has been reported of the spontaneous rupture of the kidney during an attack of nephritic colic. This rare complication is due to excessive pressure in the renal cavities caused by an obstructive ureteral calculus. Complete resolution of the urinoma was obtained after endoscopic fragmentation of the calculus and double J stenting.

Urethro-cutaneous fistula constitutes the main complication of urethroplasty for hypospadias. The frequency of this complication ranges from 12 to 90%. The multiplicity of fistula closure techniques, reflects the difficulty involved in repairing these lesions. The authors evaluated fistula repair by a double pedicle skin flap according to the Wise technique.32 patients were treated: 18 had already undergone 34 attempted repairs of urethro-cutaneous fistulas complicating urethroplasties (9 Mathieu, 17 Duplay and 6 Leveuf) for anterior penile (9), middle penile (14) and penoscrotal hypospadias (9). In 14 cases, the Wise technique was the first procedure used to repair the fistula.The authors obtained 29 successes. The 3 failures concerned fistulas after Duplay urethroplasties to correct penoscrotal hypospadias. The overall success rate of this technique in our series (90%) was therefore close to that reported by Wise (5 out of 6 successes), who described this technique in 1977.The Wise technique is a good technique for repair of large, recurrent urethro-cutaneous fistulas after several attempts of repair.

In order to locate the rate of positivity of the different markers of hepatitis that can be transmitted through blood (Ag HBs, anti-HBc Ab, anti-HCV Ab and transaminases (ALAT)), we have conducted a study over 300 blood donors and who are sale, equally shared between the parts of age and of sex. The ALAT were superior to the normalcy in 10.66% of the cases, the male sex being 3 times more affected than that of the female. The Ag HBs was positive in 4.66% of the cases. The male sex is twice as affected as the female sex. One of three persons who donated blood (37.33%) had anti-HBc Ab. Finally none of the 300 blood donors has the anti-HCV Ab. There's a very weak recovering between the presence of Ag HBs and of ALAT superior to the normalcy, a weak recovering between Ag HBs and anti-HBc Ab and a certain recovering between ALAT superior to the normalcy and the présence of anti-HBc Ab. There is no recovering between the anti-HCV Ab and the indirect markers. Eventually, the systematization of all these tests over each donation engenders the elimination of more than 2/5 of the collected products.