Performance Enhancement of Kaolin/Chitosan Composite-Based Membranes by Cross-Linking with Sodium Tripolyphosphate: Preparation and Characterization.

A new family of environmentally friendly and low-cost membranes based on readily available mineral and polymeric materials has been developed from cast suspensions of kaolin and chitosan using aqueous phase separation and polyethylene glycol as a pore-forming agent. The as-fabricated membranes were further cross-linked with sodium tripolyphosphate (STPP) in order to strengthen the properties of the obtained samples. The functional groups determined by FTIR and EDX confirmed that the reaction occurred. A detailed study of the effects of cross-linking time on the physicochemical, surface and permeation properties showed that a 30-minute reaction enabled the composite membrane to be stable in acidic media (up to pH 2) and increased the mechanical strength twofold compared to the non-cross-linked membrane. A similar morphology to that generally observed in polymeric membranes was obtained, with a sponge-like surface overlaying a finger-like through structure. The top layer and cross-section thicknesses of the membranes increased during STPP post-treatment, while the pore size decreased from 160 to 15 nm. At the same time, the molecular weight cut-off and permeance decreased due to the increase in cross-linking density. These results observed in a series of kaolin/chitosan composite membranes showed that STPP reaction can provide control over the separation capability range, from microfiltration to ultrafiltration.

Hydroxychloroquine lung pharmacokinetics in critically ill patients with COVID-19.

Different dosage regimens of hydroxychloroquine (HCQ) have been used to manage COVID-19 (coronavirus disease 2019) patients, with no information on lung exposure in this population. The aim of our study was to evaluate HCQ concentrations in the lung epithelial lining fluid (ELF) in patients infected with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), the virus that causes COVID-19. This was a retrospective, observational, multicentre, pharmacokinetic study of HCQ in critically ill COVID-19 patients. No additional interventions or additional samples compared with standard care of these patients were conducted in our teaching hospital. We included all intubated COVID-19 patients treated with crushed HCQ tablets, regardless of the dosage administered by nasogastric tube. Blood and bronchoalveolar lavage samples (n = 28) were collected from 22 COVID-19 patients and total HCQ concentrations in ELF were estimated. Median (interquartile range) HCQ plasma concentrations were 0.09 (0.06-0.14) mg/L and 0.07 (0.05-0.08) mg/L for 400 mg × 1/day and 200 mg × 3/day, respectively. Median HCQ ELF concentrations were 3.74 (1.10-7.26) mg/L and 1.81 (1.20-7.25) for 400 mg × 1/day and 200 mg × 3/day, respectively. The median ratio of ELF/plasma concentrations was 40.0 (7.3-162.7) and 21.2 (18.4-109.5) for 400 mg × 1/day and 200 mg × 3/day, respectively. ELF exposure is likely to be underestimated from HCQ concentrations in plasma. In clinical practice, low plasma concentrations should not induce an increase in drug dosage because lung exposure may already be high.

[Increased cardiovascular risk and premature atherosclerosis in rheumatoid arthritis]. / Augmentation du risque cardiovasculaire et accélération de l'athérosclérose au cours de la polyarthrite rhumatoïde.

UNLABELLED: Patients with rheumatoid arthritis (RA) are at increased risk of mortality compared with the general population. Evidence suggests that this increased mortality can largely be attributed to increased cardiovascular (CV) death. In a prospective study, 34 patients with RA were compared with age- and sex-matched controls. RESULTS: We found a lower C-HDL, apolipoprotein A1 and B in patients with RA. However, CT/C-HDL and C-LDL/C-HDL were significantly higher than control patients. The intima-media thickness was significantly higher in patients with RA (0.759 mm vs 0.558 mm; P<0.001). CONCLUSION: Increased attention to cardiovascular risk in RA will be necessary to reduce the excess CV mortality and morbidity in RA patients. It appears that the excess risk that is observed in the RA population can be explained, in part, by promotion of CV disease through increased systemic inflammation associated with RA.

[Prevalence and diagnostic value of antinuclear antibodies without identified antigenic target: a retrospective study of 90 patients]. / Prévalence et valeur diagnostique des anticorps antinucléaires de spécificité antigénique indéterminée : étude rétrospective à propos d'une série de 90 patients.

PURPOSE: The objective of this study was to determine the clinical relevance and the diagnostic significance of positive antinuclear antibodies (ANA) without identified antigenic target by the usual characterization technique. PATIENTS AND METHODS: Retrospective study conducted in the Laboratory of Immunology of Habib Bourguiba Hospital (Sfax, Tunisia) during 18 months. The inclusion criteria were the presence of an ANA titer greater or equal to 1/320 with negative characterization result. ANA screening was performed by indirect immunofluorescence (IIF) on Hep2 cells. Each positive serum was tested by IIF on Crithidia luciliae (anti-native DNA) and by immunodot (anti-nucleosome, anti-histone, anti-Sm, anti-RNP, anti-SSA, anti-SSB, anti-Scl 70, anti-PM-Scl, anti-Jo1, anti-PCNA and anti-ribosomal protein). Sera of systemic lupus erythematosus (SLE), myositis, and scleroderma patients were tested for anti-Ku, anti-PL7, anti-PL12 and anti-Ro-52 using dot myositis. RESULTS: Sera of 90 patients were studied: 18 men and 72 women (average age: 44 years). Drug-induced ANA was found in eight patients. The most frequent clinical symptoms were joint (56.7%), cutaneous (54.4%) and constitutional symptoms (45.6%). The diagnosis of an autoimmune disease was suspected in 49 patients (54.5%) and confirmed in 30 (33.3%) including 20 cases of connective tissue disease: myositis (n=6), scleroderma (n=5), Sjögren's syndrome (n=3), SLE (n=4), rheumatoid arthritis (n=6) and antiphospholipid syndrome (n=4). Other autoimmune diseases were less frequent. The anti-Ku antibody was detected in the majority of patients with connective tissue disease. The diagnosis of non-autoimmune diseases was established in 25.5% of patients. Eighteen patients (20%) had no diagnosis orientation. CONCLUSION: Our study demonstrated the diagnostic value of the presence of ANA even in the absence of known antigenic target, confirmed the role of the IIF as "gold standard" test for ANA screening, and suggested the usefulness of the addition of Ku antigen in the immunodot classic profile.

Chronic neck pain and vertigo: Is a true balance disorder present?

OBJECTIVE: We sought to establish whether chronic neck pain patients suffering from vertigo and instability have true balance disorders. PATIENTS AND METHODS: Ninety-two patients having suffered from chronic neck pain for at least 3 months were enrolled in the present study. Patients with a history of neck trauma or ear, nose and throat, ophthalmological or neurological abnormalities were excluded. The patients were evaluated in a clinical examination (neck mobility) and a test of dynamic and static balance on the Satel((R)) platform in which mediolateral (Long X) and anterior-posterior deviations (Long Y) were monitored. Our patients were divided into three groups: a group of 32 patients with neck pain and vertigo (G1), a group of 30 patients with chronic neck pain but no vertigo (G2) and a group of 30 healthy controls. RESULTS: All groups were comparable in terms of age, gender, weight and shoe size. Osteoarthritis was found in 75% and 70% of the subjects in G1 and G2, respectively. Neck-related headache was more frequent in G1 than in G2 (65.5% versus 40%, respectively; p=0.043). Restricted neck movement was more frequent in G1 and concerned flexion (p<0.001), extension (p<0.001), rotation (p<0.001), right inclination (p<0.001) and left inclination (p<0.001). Balance abnormalities were found more frequently in G1 than in G2 or G3. Static and dynamic posturographic assessments (under "eyes open" and "eyes shut" conditions) revealed abnormalities in statokinetic parameters (Long X and Long Y) in G1. CONCLUSION: Our study evidenced abnormal static and dynamic balance parameters in chronic neck pain patients with vertigo. These disorders can be explained by impaired cervical proprioception and neck movement limitations. Headache was more frequent in these patients.

MHC class I and class II genes in Tunisian patients with reactive and undifferentiated arthritis.

OBJECTIVE: To study HLA class I and class II association in Tunisian patients with reactive (ReA) and undifferentiated arthritis (UA). METHODS: The study included 17 patients with ReA defined according to the European Spondylarthropathy Study Group criteria for spondylarthropathy (SpA), 11 patients classified as having undifferentiated arthritis and 100 unrelated healthy controls. HLA class I antigens were typed serologically and HLA class II alleles were genotyped molecularly by the polymerase chain reaction with sequence-specific primers technique. RESULTS: There was a major difference between HLA alleles in ReA and UA patients when compared separately with controls. Increased frequencies of HLA-B27 (p=7.76 10-12, OR=59.30), HLA-B51 (p=0.015, OR=4.91) and HLA-DRB1*04 (p=0.033, OR=2.90) alleles were found in patients with ReA but not in patients with UA. HLA-B27 was not expressed totally in our cohort of UA patients. A significant increase of HLA-B15 (p=0.002, OR=18.40) and a moderate increase of HLA-B7 (p=0.043, OR=5.15) was found in patients with UA, but not in patients with ReA. In the B27 negative patients, HLA-DRB1*04 association with ReA was found independently of B27. CONCLUSION: Our data confirmed a significant association of HLA-B27 with ReA in the Tunisian population. Our results also suggested that some of the additional HLA antigens were associated with ReA including HLA-B51 and HLA-DRB1*04 alleles. UA seemed to have a genetic background different from ReA in Tunisian patients.

[Cutaneous leishmaniasis in rheumatoid arthritis]. / Leishmaniose cutanée au cours de la polyarthrite rhumatoïde.

INTRODUCTION: Cutaneous leishmaniasis is a protozoal infection. Its prevalence is increasing, especially in immunocompromised subjects. CASE REPORTS: We report four patients with rheumatoid arthritis, treated with methotrexate and prednisone who developed cutaneous leishmaniasis. Clinical outcome was favorable after institution of antimony therapy in three cases despite the continuation of methotrexate and prednisone. One patient failed to respond to therapy. DISCUSSION: The frequency of cutaneous leishmaniasis is increasing especially in immunocompromised subjects. In our patients, rheumatoid arthritis, corticosteroid therapy and methotrexate were predisposing factors of cutaneous leishmaniasis.

[Functional and quality of life outcome of non-operated rotator cuff tears]. / Le devenir fonctionnel et la qualité de vie des ruptures de la coiffe des rotateurs non opérées.

UNLABELLED: Our objective was to determine the long-term functional and quality-of-life outcomes for patients with rotator cuff tears receiving conservative treatment. We also studied correlations between the Constant and SF-36 scores. MATERIAL AND METHODS: This was a prospective survey carried out on patients having consulted in our Rehabilitation Department between January 1995 and December 2004 for radiologically-confirmed rotator cuff tears and having received medical treatment combined with a rehabilitation programme. The outcome measures used in our study were as follows: degree of motion, muscle strength, degree of pain on a visual analogical scale (VAS) and scores on the Constant and SF-36 scales. RESULTS: The study population consisted of 38 women and 21 men (mean age: 61 years; range 46-75). The mean final outcome measurements were taken after an average of seven years of follow-up (range: 4-12). The VAS score for pain at rest dropped from 68.3+/-31 to 28.3+/-12 (p<10(-3)) over the follow-up period. The score for pain during effort fell from 82.5+/-36 to 40.3+/-15. In all cases, active joint mobility was better at the final assessment (p<0.001). The Constant score rose from 28.8+/-14.2 to 51.6+/-21.8. The SF36 score showed a 16% improvement. Sixty-two percent of patients were satisfied or very satisfied with this treatment. The change over time was rated as good to very good by 42 patients (71.8%). The observed improvement in quality of life was correlated with reduced pain at rest (r=0.62) and during effort (r=0.59) and with the increased Constant score. CONCLUSION: Our results underline the benefits (in terms of short- and long-term pain reduction, functional improvements and better quality of life) of an individualized rehabilitation programme (combined with medical treatment) in cases of rotator cuff tears.

Knee osteoarthritis in 50 former top-level soccer players: a comparative study.

OBJECTIVES: To study the prevalence of knee osteoarthritis in a group of former top-level football players and to assess the condition's impact on joint function and structure, compared with a control group. MATERIALS AND METHODS: A cross-sectional, descriptive study was performed on a group of male former top-level football players (group G1), aged over 45 and with no history of knee trauma, arthritis, arthropathy or surgery. A second group of otherwise matched nonsporting subjects (group G2) was compared with the first group. For each subject, we specified age, weight, height, body mass index (BMI), dominant foot, the presence of knee axis deviation, the presence of pain and functional impairment. The pain level was assessed using a visual analogue scale (VAS). The functional assessment was performed using the Arabic version of the Lequesne index. Moreover, for each former player, we specified a number of sporting parameters, including those related to their playing career. The diagnosis of knee osteoarthritis was made using standard radiological and clinical criteria. The radiological severity of knee osteoarthritis was assessed using the Kellgren and Lawrence classification. We compared the two groups in terms of the frequency of knee osteoarthritis, the severity of pain and disability and the severity of structural impairment. RESULTS: Our study included two groups of patients: a group of 50 former football players (G1) with a mean age of 49.2. Overweight was noted in 40 subjects. The mean number of training hours a week was 14+/-3.5 during their professional career and 2.5 during their retirement. Half of the sportsmen had taken part in more than 200 matches. Knee axis deviation was observed in 29 former players (i.e. 58% of the cases) and 27 displayed genuvarum. A group of 50 nonsporting volunteers (G2) was matched to the G1 group in terms of age, BMI and frequency of axis deviation. Knee osteoarthritis was more common in the football players than in the nonsporting subjects (80% versus 68%), although the difference was not statistically significant. Whereas pain was noted in only six footballers (with an average VAS score of 25.4+/-6.3mm) and was observed in 50% of controls (with a mean VAS score of 39.2mm+/-7.3) (P=0.001). Disability was recorded in six sportsmen, with a mean Lequesne score of 0.38+/-1.27. Disability was more frequent (23 subjects) and more intense (with a mean Lequesne score of 1.71+/-3.2) in the nonsportsmen (P=0.001). The Kellgreen and Lawrence radiological classification revealed that 57.5% of the sportsmen had scores of III or IV, compared with just 29.4% in the control group. CONCLUSION: Knee osteoarthritis is common in male football players. However, our study shows that the condition is less painful and less likely to cause functional disability (but paradoxically more destructive) than in nonsportsmen.

[Multifocal Langerhans cell histiocytosis of bone: late revelation in a 76-year-old woman]. / Histiocytose langerhansienne osseuse multifocale: révélation tardive chez une femme de 76 ans.

Langerhans cell histiocytosis or histiocytosis X has a variable course from a self-limited eosinophilic granuloma to an aggressive disseminated disease. It mainly affects children. We report a 76-year-old woman with multifocal bone histiocytosis X, involving the rachis, an iliac bone and the skull. The diagnosis has been established by histological exam. Outcome was favourable after chemotherapy.

[Fibromyalgia prevalence in Tunisia]. / Prévalence de la fibromyalgie en Tunisie.

OBJECTIVE: to estimate fibromyalgia (FM) prevalence in Tunisia. METHODS: Data on a cross-section of 1000 individuals aged 15 years or older living in Sfax were collected by interviewers using the London Fibromyalgia Epidemiology Study Screening Questionnaire (LFES- SQ). The sampling was realized by empirical poll and respecting quota according to delegation, rural or urban environment, sex and age according to the demographic national data. The positive screened subjects were invited to be examined to confirm or exclude the FM by applying the 1999 ACR criteria. The questionnaire was administered to a second group of 252 volunteers, all were afterward examined. This allowed to study specificity and sensibility of the questionnaire and allowed to calculate the FM prevalence. RESULTS: 159 subjects were screened positive, only 141 were examined. The specialized exam allowed confirming the diagnosis of FM in 67 subjects. FM prevalence is different according to sex, age, study level and socio-economic level. Two hundred and fifty two volunteers answered the questionnaire then all examined. The questionnaire specificity was 90.8% and the sensibility 79.4%. FM prevalence in Tunisia, calculated by Bayes theorem, is estimated between 8.27% and 12.3%. CONCLUSION: FM prevalence in Tunisia is estimated at least at 8.27%.

[Abdominal obesity and knee ostheoarthritis]. / Obésité abdominale et gonarthrose.

UNLABELLED: The objective of our study was to determine whether waist circumference (WC) is a more reliable indicator than body mass index (BMI) of the presence of knee osteoarthritis in obese subjects. PATIENTS AND METHODS: We performed an observational study of obese patients with no other risk factors for knee osteoarthritis. For each patient, we evaluated BMI, WC, duration of obesity and knee pain. Two groups were identified: "asymptomatic patients" (AG), without knee pain, and "symptomatic patients" (SG). For the SG, we measured pain intensity (visual analog scale [VAS], 0-100 mm) and functional repercussions (using the Lequesne and WOMAC indexes). Patients with knee pain underwent standard radiographic procedures to search for signs of osteoarthritis, and the SG was divided into two subgroups: with radiological signs of osteoarthritis (SG-1) and without radiological signs of osteoarthritis (SG-2). The AG and SG groups and SG-1 and SG-2 groups were compared for age, sex, and duration of obesity. Comparisons of BMI, WC, and function involved the Student's t-test. RESULTS: We recruited 56 patients for the study (82.5% females; mean obesity duration (13+/-6.5 years; mean age 43.21+/-9.58 years). The mean BMI was 39.6+/-7.23 kg/m(2) and mean WC was 113+/-14.3 cm. We found 33 patients (59%) with knee pain. Independent of age, sex, duration of obesity and BMI, the SG showed more significant WC (117.27+/-14.71 cm vs. 107+/-11.75 cm for the AG, P 0.01). In the same group and independent of the already mentioned factors, the patients with radiological signs of osteoarthritis showed significant WC [122+/-15.57 cm (SG-1) vs. 108+/-6.88 cm (SG-2) (P 0.01)]. Moreover, the VAS score of pain at rest and during effort and the WOMAC and Lequesne scores were 16+/-25.7 mm, 75+/-18.3 mm, 12.3+/-8.92 and 11.5+/-5.44 (SG-1) and 7+/-18.4 mm, 70+/-19.2 mm, 5.7+/-3.05, and 6.9+/-3.79 (SG-2), respectively. The difference between SG-1 and SG-2 was significant only for the WOMAC (P=0.015) and Lequesne (P=0.026) scores. CONCLUSION: Independent of BMI, WC appears to be a factor associated with the presence of knee pain and osteoarthritis in obese patients. Furthermore, a high WC is associated with significant functional repercussion.

[Chronic low back pain and vertebral manipulation]. / Les lombalgiques chroniques et manipulations vertébrales. Etude prospective à propos de 64 cas.

OBJECTIVE: This study examined the short-term effectiveness of vertebral manipulation for treating chronic low back pain and disability. METHODS: Sixty-four patients were randomly assigned into two groups. One group received 4 true vertebral manipulations (VMG), and the other group received sham manipulations (sham-VMG) under the same conditions as for the first technique. Patients formulated assessments after the manipulations and 1 month later. RESULTS: Sixty-four patients participated in the study. Patients receiving the true manipulations showed significant improvement in pain (visual analogic scale score decrease from 71.8+/-18.11 to 49.37+/-16.78; P<0.001) and function (Oswestry scale score decrease from 15.59+/-6.03 to 12.25+/-5.69; P<0.001). Pain improvement persisted at the second month (P=0.01). The improvement was more evident in the VMG than the sham-VMG. No change in perceived disability was observed in the sham-VMG. CONCLUSION: Our study confirms the efficiency of short-term vertebral manipulation for treating chronic low back pain. The assessment of vertebral manipulation effectiveness is difficult. This manual therapy must be preceeded by a specific clinical exam performed by a trained physician.

[Algodystrophy of the lower limbs during pregnancy]. / Algodystrophie des membres inférieurs au cours de la grossesse.

Algodystrophy (AD) of the lower limbs during pregnancy is rare and probably underdiagnosed. The physiopathologic mechanisms remain under discussion and seem multiple and complex. This report describes a retrospective survey of 6 patients seen between 1993 and 2004 who had algodystrophy of the lower limbs during pregnancy. Comparing the clinical, radiological and evolutionary results to the literature allows for identifying the main features of AD during pregnancy: disease progression during the second or third trimester, preferential localization of the left hip associated or not with other lower limb joint involvement and decalcification as seen on radiography. Magnetic resonance imaging (MRI), which is accurate, specific and non-invasive, is currently the exam of choice in early and differential diagnosis. The evolution is favourable in a few months, with general recovery without disability.

[Autoantibodies in systemic lupus erythematosus: spectrum and clinical associations]. / Autoanticorps dans le lupus érythémateux systémique: profil et corrélations cliniques.

We have analysed the clinical features and autoantibody profile of 84 tunisian patients with newly diagnosed systemic lupus erythematosus (SLE). Antinuclear antibodies (ANA) were detected by an immunofluorescence method, anti-dsDNA and anti-cardiolipin (aCL) antibodies by ELISA, antinucleosome and anti-extractible nuclear antigens (or anti-ENA: anti-Sm, anti-RNP, anti-SSA and anti-SSB) by immunodot. The mean age of the patients was 29,9 years and the sex-ratio F/M was 6. The most common initial features were haematological (80%), rheumatological (78%) and cutaneous (75%) disorders. 59% of the patients had glomerular nephropathy. ANA were detected in 97.6%, antinucleosome in 78.6%, anti-dsDNA in 75%, anti-histones in 44%, anti-Sm in 36.9%, anti-RNP in 32.1%, anti-SSA in 54.8% and anti-SSB in 14.3% of patients. IgG and IgM aCL were detected in 45 and 40% of the patients respectively. The significant clinical associations were those of nephropathy and disease activity with anti-dsDNA and antinucleosome antibodies. Our results confirm the clinical polymorphism of SLE, the high frequency of antinucleosome antibodies at time of diagnosis and the predominance of anti-SSA among anti-ENA antibodies.

Clinical significance of antinucleosome antibodies in Tunisian systemic lupus erythematosus patients.

The aim of this study was to investigate the clinical significance of antinucleosome antibodies in Tunisian systemic lupus erythematosus (SLE) patients. IgG antinucleosome antibodies were detected by a qualitative enzyme immunoassay (immunodot) in the sera of SLE patients at onset of disease. The patients were divided into two groups according to the result of the antinucleosome antibodies test: positive (group A) and negative (group B). The two groups were also evaluated for clinical and biological parameters. Of 84 patients with SLE, 66 (78.6%) had antinucleosome antibodies. Among 21 patients negative for anti-double-stranded DNA (anti-dsDNA), 5 (23.8%) were antinucleosome positive. The most common initial features were haematological disorders (80.1%) and arthritis or arthralgias (79.8%). Renal disorders, observed in 59.5% of SLE patients, were more common in group A compared to group B (65 vs 38%) (p=0.04). The European Consensus Lupus Activity Measurement (ECLAM) mean score was higher in group A (6.42) than in group B (4.44) (p=0.002). Antinucleosome antibodies were positive in nearly one-fourth of SLE patients negative for anti-dsDNA. We found a correlation between antinucleosome antibodies, nephritis and SLE disease activity. Therefore, the determination of circulating antinucleosome antibodies could be a useful parameter for early diagnosis and follow-up of SLE patients.

[The Oswestry index for low back pain translated into Arabic and validated in a Arab population]. / Traduction en arabe et validation de l'indice d'Oswestry dans une population de lombalgiques Nord-Africains.

OBJECTIVE: To translate into Arabic and validate the Oswestry index for low back pain in an Arab population. BACKGROUND: No functional disability index to assess low back pain written in the Arabic language and validated in an Arab population is available. DESIGN: Arabic translation of the Oswestry index was obtained by the "forward translation/backward translation" method. Adaptations were made after a pilot study involving ten patients aged 18 to 65 years old. Impairment outcome measures (pain as measured on a visual analog scale [VAS], Schober-McRae, index, duration of morning stiffness and number of night awakenings), disability (Quebec index, Waddell index), handicap (as measured on a VAS) and Beck depression scale scores were recorded. Inter-rater reliability was assessed by use of the intra-class correlation coefficient (ICC) and the Bland and Altman method. Construct validity was investigated with use of the Spearman rank correlation coefficient (convergent and divergent validity), and factor analysis was performed. Internal consistency was assessed by use of the Cronbach alpha coefficient. RESULTS: Eighty Tunisian patients with low back pain were included in the validation study. Two items were excluded. Inter-rater reliability was excellent (ICC = 0.98). Expected divergent and convergent validity results suggested good construct validity. Two main factors were extracted by factor analysis and explained 58.19% of the cumulative variance: the first factor represented discomfort in dynamic activities, the second discomfort in static activities. The Cronbach alpha coefficient was 0.76 for factor 1 and 0.70 for factor 2. CONCLUSION: We translated into and adapted the Oswestry index for the Arabic language in a population of Tunisian women? with low back pain. The 8-item version is reliable and valid. Although the scale was validated in a Tunisian population, we expect that it is suitable for other Arab populations, especially North Africans. Further study is needed to confirm such a hypothesis.

[Monoclonal gammapathies in Tunisia: epidemiological, immunochemical and etiological analysis of 288 cases]. / Gammapathies monoclonales en Tunisie: analyse épidémiologique, immunochimique et étiologique d'une série de 288 cas.

From July 1992 to December 2000, 288 cases of monoclonal gammapathy (MG) were collected at the university hospital of Sfax. The middle age of the patients at the time of the diagnosis was 62 years and 7 months with extremes to 18 months and 99 years and median to 64 years. One hundred and eighty-two patients were men and 106 women. Among the 270 observations for which aetiology has been established, 73 were classified MG of undetermined significance (MGUS), 160 myeloma (or plasmocytoma) and 37 other malignant MG (Waldenstrom's macroglobulinemia: 13, lymphoma: 9, alpha heavy chains disease: 6, primary amyloidosis: 5, chronic lymphocytic leukaemia: 4). Rheumatological affections (19.2%), infections and renal failure (10% each), haematological and autoimmune diseases (9.6% each) were pathologies most often associated with MGUS. Agarose gel electrophoresis did not show a monoclonal peak in 16% of the cases. In the 242 patients with a peak on electrophoresis, the peak was in the beta zone in 22% of cases and in the gamma zone in 78% of cases. The IgG isotype represents more than the half of the cases of our set (51.7%). IgG is even more predominant in the MGUS group (65.8%). The IgA isotype counts for 20.8% of the cases in our set and the free light chains (kappa or lambda) for 13.6% of the cases whereas the IgM represents 8.7% only of the 288 cases of our set which involves three cases of IgD myeloma and six cases of biclonal gammapathy.