Impact and long-term protection of hepatitis B vaccination: 17 years after universal hepatitis B vaccination in Tunisia.

Hepatitis B virus (HBV) vaccination has been part of the Expanded Programme of Immunization (EPI) in Tunisia since 1995. The aim of this study was to evaluate, for the first time, the impact of mass vaccination in Tunisia 17 years after this programme was implemented, and in parallel, assess the long-term persistence of anti-HBs antibody in the vaccinated Tunisian population. A total of 1422 students were recruited (703 vaccinated, 719 non-vaccinated). HBV seromarkers were checked. None of the students from either group had positive HBsAg. The overall prevalence of anti-HBc was 0·8%. A Significantly higher prevalence of anti-HBc was noted in unvaccinated students than in vaccinated (1·4% vs. 0·3%, P = 0·02). The overall seroprotection rate (anti-HBs titre ⩾10 mIU/ml) was 68·9% in vaccinated subjects. Seroprotection rates and geometric mean titres decreased significantly with increasing age, reflecting waning anti-HBs titre over time. No significant difference was detected between seroprotection rates and gender or students' area of origin. Incomplete vaccination was the only factor associated with an anti-HBs titre <10 mIU/ml. This study demonstrates the excellent efficacy of the HBV vaccination programme in Tunisia 17 years after its launch. However, a significant decline of anti-HBs seroprotection has been observed in ⩾15-year-old adolescents which places them at risk of infection. Additional studies are needed in hyperendemic regions in Tunisia.

Bishop Score vs. ultrasound cervical length in the prediction of cervical ripening success and vaginal delivery in nulliparous women.

AIM: The aim of this paper was to compare the predictive value of Bishop Score and sonographic measurement of cervical length for predicting cervical ripening success and vaginal delivery in nulliparous women with low Bishop Score. METHODS: A prospective observational study including 77 nulliparous pregnant women at exactly 41 weeks of gestation with a Bishop Score ≤ 5. Cervical measurement was performed by transvaginal ultrasonography and Bishop Score was determined by digital examination. All patients had cervical ripening with Prostaglandins prior to labor induction with oxytocin. RESULTS: Cervical ripening was successful in 63 patients (81%) and vaginal delivery occurred in 51 women (66.2%). Multiple logistic regression analysis demonstrated cervical length assessed by transvaginal sonography as the only independent predictor of successful cervical ripening and vaginal delivery. The best cut-off point was 34.6 for predicting successful cervical ripening and 32.5 mm for predicting vaginal delivery. The chance of vaginal delivery was 90% when initial cervical length was < 32.5 mm and 50% when cervical length was >32.5 mm. CONCLUSION: Compared with the Bishop score, ultrasound cervical length measurement is a better predictor of cervical ripening success and vaginal delivery in nulliparous women at 41 weeks of gestation with an unfavorable cervix.

Identification of soluble and membrane antigenic markers of acquired toxoplasmosis by immunoblot.

The overall performance of quantitative assays in the detection of anti-Toxoplasma IgG is satisfactory, but discrepancies between assays are not uncommon especially when IgG concentrations are close to the limit of detection of the tests. The purpose of our study was to identify soluble and membrane antigens extracted from Toxoplasma gondii tachyzoites by immunoblot to select the most relevant antigenic bands to be used for qualitative serodiagnosis of acquired toxoplasmosis. We selected five relevant bands (98, 36, 33, 32 and 21 kDa) with soluble antigens and four relevant bands (42, 35, 32 and 30 kDa) with membrane antigens which gave high sensitivity and/or specificity in immunodiagnosis. The association on the same blot of at least three of the five relevant bands in the soluble antigen immunoblot showed the highest sensitivity/specificity (97.4%/99.0%, respectively). Our results indicate that immunoblot using soluble tachyzoite extract with simultaneous detection of at least three of the five bands (98, 36, 33, 32 and 21 kDa) represents a valuable test for serodiagnosis of acquired toxoplasmosis and should be further evaluated as a confirmatory test for sera which give discrepant results in quantitative assays.

[Adherence to antiretroviral therapy in HIV-infected patients in Sousse, Tunisia]. / Observance au traitement antirétroviral chez les patients infectés par le VIH à Sousse, Tunisie.

Adherence to antiretroviral therapy (ART) is a powerful predictor of survival for individuals living with human immunodeficiency virus (HIV). The purpose of this cross-sectional study conducted in December 2007 was to assess ART adherence and identify its determinants in HIV-infected patients in Sousse, Tunisia. Adherence was evaluated in a structured interview, during which questions were asked about the number of pills taken, treatment schedule, and any food restrictions within the previous 4 days. Determinants of adherence included patient characteristics, type of ART, and interpersonal relationships and were assessed from the medical records and questionnaire responses. Adherence was assessed in 30 of the 34 patients receiving ART at the time of the study. Twenty-two patients (73%) complied with all daily treatment recommendations and were considered adherent. Multivariate analysis showed that the main barriers to adherence were related to storage of the medication and doubts about its efficacy. Improvement of socioeconomic conditions and better psychosocial support are needed to optimize ART adherence by HIV-infected patients in Tunisia.

[Evaluation of the immunoblotting for the detection of immunoglobulin G Toxoplasma antibodies in immunocompetent patients]. / Apport de l'immunoblot dans la détection des IgG anti-toxoplasmiques chez le sujet immunocompétent.

UNLABELLED: The serological tests commonly used for the diagnosis of toxoplasmosis raise the problem of the interpretation of the borderline immunoglobulin G (IgG) levels and discordant results between various tests. OBJECTIVE: The purpose of our study was to evaluate the contribution of the immunoblotting in the detection of specific IgG in acquired toxoplasmosis of immunocompetent patients especially when levels are equivocal or discordant in enzyme-linked immunosorbent assay (Elisa) and indirect fluorescent antigen test (IFAT). MATERIAL AND METHODS: [corrected] We tested three groups of sera. The first included 87 positive sera, the second 33 negative sera, and the last one 29 equivocal sera. RESULTS: Results obtained with the first and the second group of sera led us to identify the bands 30kDa and 32kDa as markers of the toxoplasmic infection. The simultaneous presence of both bands showed a sensitivity of 91.5%, a specificity of 96.9%, a VPP of 98.7%, a VPN of 74.4% and a Youden's index of 0.88. Our findings suggest that the presence of these two bands is a reliable criterion for the confirmation of the presence of anti-toxoplasmic IgG in the corresponding serum. The immunoblot allowed us to ascertain serological status of 27 (93.1%) patients from the third group in which results were discrepant or equivocal in Elisa and/or in IFAT. CONCLUSION: Immunoblot is a useful serological test for detection of very low or equivocal titers.

[Mycological and epidemiological aspects of tinea capitis in the Sousse region of Tunisia]. / Aspects mycologiques et épidémiologiques des teignes du cuir chevelu dans la région de Sousse (Tunisie).

AIM: Tinea capitis continues to be considered a public health problem in Tunisia. The purpose of our study was to investigate trends in the incidence and the mycological and epidemiological aspects of tinea capitis in the Sousse region (Central Tunisia). METHOD: Our work is a retrospective study concerning all scalp samples taken by the parasitology laboratory of the Farhat Hached Hospital in Sousse, Tunisia, over a 26-year period (1983-2008). RESULTS: A total of 10,505 specimens were examined. Of these, 5593 were positive with positive direct examination and/or positive culture. The average incidence was 215 cases per year. Patients were aged under 12 years in 89.3% of cases. A total of 175 cases of tinea capitis in adults were diagnosed. Ten dermatophyte species were isolated: Trichophyton (T.) violaceum (66.7%), Microsporum (M.) canis (29.3%), T. schoenleinii (1.6%), T. mentagrophytes (1.1%), T. verrucosum (0.6%), T. tonsurans (0.2%), T. rubrum (0.2%), M. gypseum (0.1%), M. audouinii (0.03%) and M. nanum (0.01%). CONCLUSION: Our study showed a decrease in the annual incidence of tinea capitis over the study period with an evident decrease in trichophytic tinea and disappearance of favus giving way to microsporic and inflammatory tinea.

Spirometric profile of narghile smokers.

INTRODUCTION: Studies of the spirometric profiles of narghile smokers are few, have some methodological limits (i.e. small sample size), and present contradictory conclusions. AIMS: (i) To determine the percentage of narghile smokers with obstructive ventilatory defect (OVD) and/or restrictive ventilatory defect (RVD) or static hyperinflation (SHI); (ii) to compare the chronological and estimated lung ages. INCLUSION CRITERIA: men aged 20 to 60 years, narghile smokers (>1 narghile-year [NY]). EXCLUSION CRITERIA: cigar or cigarette smokers and comorbidity. Narghile use quantification: NY and kg of cumulative tobacco use (1 NY=9.125 kg of cumulative tobacco use). DEFINITIONS: Large airway obstructive ventilatory defect (OVD): forced expired volume in one second (FEV(1))/forced vital capacity (FVC) less than lower limit of normal (LLN). Small airway OVD: FVC more than LLN and decrease (less than LLN) of one or more peripheral flows. RVD: total lung capacity (TLC) less than LLN. SHI: residual volume (RV) more than upper limit of normal. SPIROMETRIC MEASURES: (Vmax 22 Series/6200 Autobox, SensorMedics, Yorba Linda, California, USA with measurement of functional residual capacity by nitrogen washout). Measurements were made according to international recommendations. RESULTS: One hundred and ten narghile smokers were included (34±10 years; 1.76±0.07m; 84±14kg). Thirty-six percent of the subjects had SHI; 14% had small airway OVD; 14% had RVD, and 6% had large airway OVD. Estimated lung age was higher than chronological lung age (47±18 years vs. 34±10 years, P<0.05). CONCLUSION: Narghile use accelerates lung ageing. This study provides the health authorities with valid arguments to fight this blight on society, which increasingly involves children and pregnant women.

[Respiratory morbidity in family practice in the region of Sousse, Tunisia]. / La morbidité respiratoire en médecine générale dans la région de Sousse (Tunisie).

We determined the profile of respiratory morbidity in family practice in the region a cross-sectional study in 86 primary health care centres in Souse over 1 year (2002-03). Medical records for 3 weeks per season were randomly selected. The International Classification of Primary Care (ICPC) was used to code recorded data. Respiratory diseases ranked first both for reason for consultation (8397/24 882, 33.7%) and for diagnosis made (7788/18 097, 43.0%). Of the 7715 respiratory complaints, cough was the most common complaint (54.8%). Of respiratory diagnoses, 37.1% were acute tonsillitis, 26.5% acute bronchitis and 21.6% were acute respiratory tract infection. Children under 5 years were most affected by acute upper respiratory tract infections (44.5%). Acute bronchitis was the primary diagnosis for patients aged over 45 years.

[Prescribing practices of fluoroquinolones in Tunisia]. / Evaluation des pratiques de prescription des fluoroquinolones en médecine de ville en Tunisie.

The aim of the study was to assess the prescribing practices of fluoroquinolones (FQ) among general practionners in the town of Sousse (central-eastern Tunisia). A transversal study was made between the first and the 23rd April, 2009, among general practionners working in Sousse. For each prescription, informations about patients, indications and modalities of treatment were collected on a questionnaire. These prescriptions were compared to Tunisian and/or French guidelines for antibiotics use. One hundred and eighty eight FQ prescriptions were analyzed. The mean age of patients was 50 years. FQ were more often used alone (83%) and in first line intention (84%). The molecules used were essentially ciprofloxacin (44.7%), levofloxacin (35.6%) and ofloxacin (18.6%). The indications were mainly bronchopulmonary infections (34%) and urinary tract infection (32%). These choices were in accordance with guidelines in 41% of the prescriptions. The dosage was adapted, but the duration of treatment was often excessive. Further efforts are needed, to optimize the good use of FQ in order to reduce or stabilize the rate of bacterial resistance.

[Correlation of TIMI risk score with angiographic extent and severity of coronary artery disease in non-ST-elevation acute coronary syndromes]. / Corrélation du score TIMI avec l'étendue et la sévérité de l'atteinte coronaire dans les syndromes coronariens aigus sans sus-décalage de ST.

AIM OF STUDY: To determine whether the TIMI risk score correlates with the angiographic extent and severity of coronary artery disease in patients with non-ST-elevation acute coronary syndrome undergoing cardiac catheterization. PATIENTS AND METHOD: We conducted a retrospective review of 239 medical records of patients who underwent coronary angiography secondary to non-ST-elevation acute coronary syndrome between 2002 and 2006. Patients were classified into three groups according to TIMI risk score: TIMI scores 0 to 2 (group 1: n=121), 3 to 4 (group 2: n=100), and 5 to 7 (group 3: n=18). We compared the coronary angiography findings of the three groups. RESULTS: Patients of group 1 had a greater likelihood of normal or non significant CAD than patients of group 2 (36.3 % vs 13 %, P<0.001) and than patients of group 3 (36.3 % vs 0 %, P=0.002). One-vessel disease was found more often in patients with TIMI score 0 to 2 than in patients with TIMI score 5 to 7 (28.9 % vs 0 %; P=0.01), and in patients with TIMI score 3 to 4 than in those with score 5 to 7 (35 % vs 0 %, P=0.006). However, 1-vessel disease was found in patients of group 1 as often as in patients of group 2. The frequency of two-vessel disease was similar whatever the level of TIMI score was low, intermediate or high. Three-vessel or left main disease was more likely found in patients of group 3 than in patients of group 2 (66.7 % vs 26 %; P=0.01), and than patients of group 1 (66.7 % vs 13.2 %; P<0.001). Chronic coronary occlusions and coronary calcifications were also more likely found in patients with TIMI score 5 to 7. CONCLUSION: In patients with non-ST-elevation acute coronary syndrome undergoing cardiac catheterization, the TIMI risk score correlated with the extent and severity of coronary artery disease.

[Influence of diabetes mellitus on the prognosis of non-ST-elevation acute coronary syndromes]. / Influence du diabète sucré sur le pronostic des syndromes coronariens aigus sans sus décalage de ST.

AIM OF STUDY: Analyze the influence of diabetes mellitus on the prognosis, at short and middle term of patients with non-ST-segment-elevation acute coronary syndrome. PATIENTS AND METHOD: We conducted a retrospective review of 308 consecutive medical records of patients admitted to the care unit of our department with a non-ST-segment-elevation acute coronary syndrome. One hundred and fifty-six patients were diabetics (group 1) and 152 were not (group 2). We compared the demographic, clinical, angiographic and therapeutic characteristics of the two groups and we analyzed the prognosis of diabetic and non-diabetic patients at short term (30 days) and at middle term (average: 28 months; extreme: 12 months, 72 months). RESULTS: The mean age was similar into both groups (60.8 years). Diabetic patients were more often women (42.1% vs 23.1%) and presented a higher prevalence of systemic hypertension, dyslipidemia and family history of coronary artery disease. Smoking was more frequent in group 2. The rates of coronary angiography, percutaneous transluminal coronary angioplasty, and coronary bypass surgery were similar in the two groups. At 30 days, diabetic patients were at increased risk for acute heart failure (19.1% vs 6.4%) and for major cardiac events (12.5% vs 6.4%). A pejorative prognosis was also observed at middle term among diabetic patients. They were at greater risk for readmissions for non-ST-segment-elevation acute coronary syndrome (42% vs 25%), for major cardiac events (49.3% vs 31.6%) and for new revascularizations (17.3% vs 7.2%). In a Cox multivariate analysis, diabetes mellitus remains an independent risk factor for major cardiac events at middle term. CONCLUSION: Our study confirms the pejorative prognosis of acute coronary syndromes without ST elevation at short and middle term in diabetic patients.

[Submaximal exercise capacity and quality of life in exclusive water-pipe smokers]. / Aptitude aérobie sous-maximale et qualité de vie des fumeurs exclusifs de narguilé

BACKGROUND: It is well known that oxidative stress is increased significantly by regular water-pipe smoking (WPS). This could lead to muscle dysfunction and thus to impairments of exercise and quality of life (QOL). Considering the impressive number of WP smokers, we intend to investigate the potential effect of WPS on submaximal exercise capacity and QOL. AIMS: (1). To evaluate the submaximal exercise capacity by the 6-minutes walking test (6-MWT). (2). To compare the deficiency, incapacity and QOL data of exclusive WPS with those of two control groups (never smokers and exclusive cigarette smokers). (3). To determine the factors influencing the 6-minutes walk distance (6-MWD) of WPS subjects. METHODS: A multicentre study including 180 exclusive WPS [> or =5 WP-year] men aged > or =40 years. Cigar or cigarette smoking, contraindications to the 6-MWT or cortico-steroid therapy will be exclusion criteria. QOL evaluation, spirometry, electrocardiogram and two 6-MWT will be performed. Signs of exercise impairment will be: 6-MWD< or =lower limit of normal, end of walk dyspnoea > or =5/10, haemoglobin saturation fall > or =5 points. Data from WPS subjects will be compared with those from 90 never smoking subjects and 90 exclusives cigarettes smokers. EXPECTED RESULTS: (1). WPS will affect significantly the submaximal exercise capacity. (2). Resting spirometric, 6-MWT and QOL data of exclusive WPS subjects will be significantly reduced compared to never smoking subjects. (3). The 6-MWD's of exclusive WPS subjects will be significantly influenced by cumulative WP consumption, by resting spirometric data, by obesity and by physical activity score.

[Evaluation of the deficiency and the submaximal exercise capacity in obstructive sleep apnoea patients]. / Exploration de la déficience et de l'incapacité des patients atteints d'un syndrome d'apnées hypopnées obstructives du sommeil.

BACKGROUND: In addition to excessive daytime somnolence, exercise limitation is a likely consequence of the cardiorespiratory problems that occur in patients who have obstructive sleep apnoea (OSA). However, few studies have evaluated the aerobic capacity of this patient group. AIMS: To evaluate submaximal exercise capacity over the 6-minute walking test (6-MWT). To determine the factors that influence 6-minutes walking distance (6-MWD). INCLUSION CRITERIA: 120 consecutive patients with severe OSA treated by continuous positive airway pressure who were medically stable will be included. EXCLUSION CRITERIA: 6-MWT contraindications, orthopaedic or rheumatologic diseases likely to influence walking capacity and corticosteroid therapy. INVESTIGATIONS: polysomnography, electrocardiogram, plethysmography, and two 6-MWT's. Indicators of impaired exercise capacity: stops during the walk, 6-MWD less than or equal to predicted lower limit of normal, end walking dyspnoea greater than or equal to 5/10, oxygen saturation fall greater than or equal to five points, end walking heart rate less than or equal to 60 % maximal predicted. Data from our obese patients aged 40-60 years old will be compared with data from 45 age-matched obese subjects free from OSA. EXPECTED RESULTS: OSA will significantly affect the submaximal exercise capacity and will accelerate the ageing of the cardiorespiratory-muscle chain. Submaximal exercise capacity of obese subjects having OSA, compared to subjects free from OSA, will be significantly deteriorated. 6-MWD of OSA patients will be significantly influenced by: resting plethysmographic data, apnoea hypopnoea index, arterial hypertension, obesity or smoking histories.

[Second epidemic of West Nile virus meningoencephalitis in Tunisia]. / Une deuxième épidémie de méningo-encéphalite à virus West Nile en Tunisie.

UNLABELLED: The West Nile virus (WNV) re-emerged in Tunisia in 2003, causing an outbreak of meningoencephalitis. OBJECTIVE: The authors studied the epidemiological, clinical, biological, and imaging features of WNV-associated neurological disease observed in central eastern Tunisia. DESIGN: A retrospective descriptive study was made on patients with West Nile meningitis and/or encephalitis observed in the Sousse area, from August 15 to November 15, 2003. Screening for specific anti-WNV antibodies in serum was performed with Elisa. RESULTS: Recent central nervous system infection due to WNV was confirmed in 21 patients with a mean age of 53 years and a sex ratio of 3.2. The clinical presentation was meningitis in 11 cases, meningoencephalitis in seven cases, and encephalitis in three cases. Patients with encephalitis were older than those with meningitis. An acute flaccid limb paralysis was observed in three patients. The CSF assay showed lymphocytosis, high protein (67 %), and normal glucose levels (83 %). Brain CT scan and MRI were normal. Three patients died, the remaining evolved uneventfully. CONCLUSIONS: These first cases of WNV meningoencephalitis in Sousse area suggest a possibility of reemergence of this infection. Preventive measures and epidemiological surveillance are necessary.

[Spirometric profile of narghile smokers]. / Profil spirométrique des fumeurs de narguilé

INTRODUCTION: Studies of the spirometric profile of narghile smokers are few, have some methodologic limits (ie. small sample size) and present contradictory conclusions. OBJECTIVE: (i) To determine the percentage of smokers having an obstructive ventilatory defect (OVD) and/or a restrictive ventilatory defect (RVD) or static hyperinflation (SHI). (ii) To compare the chronological and the estimated lung ages. INCLUSION CRITERIA: men aged 20-60 years smoking narghile (>1 narghile-year (NA). Non-inclusion criteria: cigar or cigarettes smoker and co-morbidity. Narghile consummation quantification: NA and kg of cumulated tobacco (1 NA=9.125 kg of cumulated tobacco). DEFINITIONS: large airway OVD: FEV1/FVCLLN and forced mid expiratory flowupper limit of normal. Spirometric measures (Vmax 22 Series/6200 Autobox, Yorba Linda, California, USA with measurement of functional residual capacity by nitrogen washout). Measurements were made according to international recommendations. RESULTS: 110 narghile smokers were included (34+/-10Yr; 1.76+/-0.07m; 84+/-14kg). 36% of subjects had SHI; 14% had small airway OVD; 14% had RVD and 6% had large airway OVD. (ii) Estimated lung age was higher than the chronological lung age (47+/-18Yr vs 34+/-10Yr, p<0.05). CONCLUSION: Narghile consumption accelerates ageing of the lung. This study provides the health authorities with valid arguments to fight this blight on society which increasingly involves children and pregnant women.

[Diagnosed morbidity in primary health care in the sanitary region of Sousse (Tunisia)]. / La morbidité diagnostiquée en première ligne dans la région sanitaire de Sousse (Tunisie).

Primary health care is one of the pillars of the Tunisian health care system. However, we have very little information about the specificities of general practice and the patterns of the morbidity encountered in this field. This study was interested on the diagnosed morbidity in primary health care settings. We aimed to illustrate the patterns of morbidity in general practice and identify the main diagnoses which are established by the general practitioners (GPs). The study design was descriptive and cross-sectional. 85 (out of 92) primary health centres of the province of Souse (Tunisia) have been included during one year, from June 2002 to May 2003. We have targeted a representative sample of 16.271 encounters in these primary care settings. On the methodological plan, we proceeded by a poll to two degrees; the first concerned the weeks within every season: 3 weeks were drawn out by lot; the second interested the encounters, proceeding by a systematic pull and the step of poll was fixed to 5. The International Classification of Primary Care (ICPC) was used to code recorded data. The main results of this study showed that among the 16.271 patient-doctor encounters we registered 24.882 reasons for encounter (RFE) (1.9 +/- 0.8 per encounter), 18.097 diagnoses (1.3 +/- 0.5 per encounter), and 40.190 procedures (3.2 +/- 1.9 per encounter). In this paper we have only explored the results of encounters related to the decision of general practitioners, i.e. the diagnosed morbidity. With regard to sex distribution there was a predominance of females (62%). The study population was relatively young as 50% were aged less than 25 years. According to ICPC chapters, we found that respiratory diseases were the main established diagnoses (43%) followed by digestive (10.1%), locomotive (8.9%) cardiovascular affections (8.7%) and skin diseases (8.4%). These five affections constituted alone about 80% of the total.

[Spirometric reference equations for Algerians aged 19 to 73 years]. / Equations de référence spirométriques des Algériens âgés de 19 à 73 ans.

INTRODUCTION: The validity of using European reference equations in the interpretation of spirometry results in Algerian patients has not been assessed. AIMS: (i) to establish Algerian spirometric reference equations and (ii) to compare them with European ones. METHODS: A medical questionnaire was administered. Gender, age, height, weight, lean mass (LM), percentage of fat mass (%FM) and body mass index (BMI) were noted. Spirometric variables were measured using a body plethysmograph according to international guidelines. Simple and multiples linear regressions were performed. The measured forced expiratory volume (FEV1), forced vital capacity (FVC) and the ratio between FEV1 and slow vital capacity (FEV1/SVC) were compared with those predicted from European reference equations. RESULTS: 273 healthy subjects (120 women) were included (age: 42+/-14 years; height: 1.69+/-0.10 m; weight: 74+/-13 kg; LM: 59+/-10 kg;%FM: 21+/-6%; BMI: 26+/-6 Kg.m-2). (i) Algerian reference equations explained 17% to 68% of the variability of parameters tested. (ii) The European reference equations significantly underestimated the measured FEV1, FVC and the FEV1/SVC ratio (respectively, 0.38+/-0.45 L, 0.36+/-0.55 L, and 0.01+/-0.06). CONCLUSION: The use of Algerian spirometric reference equations should improve the accuracy of lung function interpretation in this population.

[Conjugal progressive systemic sclerosis]. / Sclérodermie conjugale.

INTRODUCTION: Familial occurrence of progressive systemic sclerosis is unusual. The occurrence of conjugal scleroderma is exceptional. EXEGESIS: We report here a case of systemic sclerosis in a wife and husband who both developed the onset of illness within a 10-year period. Solvent exposure was noted. CONCLUSION: The etiology of systemic sclerosis remains unknown. Environmental factors may play role in its pathogenesis.