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Introduction: The electronic cigarette is a new-generation smoking product whose mechanism of use could, in theory, minimize adverse health effects., Aim: Determine the knowledge and perceptions of a sample of Tunisian doctors regarding electronic cigarettes., Methods: We conducted a descriptive cross-sectional study over a two-month period with a sample of Tunisian doctors. We used an online self-questionnaire on physicians' knowledge and perceptions of e-cigarettes., Results: Data were obtained from 216 physicians. Of the participants, 97.2% were familiar with e-cigarettes, 56.5% reported low knowledge, and 83.4% expressed motivation to learn more about e-cigarettes. Overall, 83.8% of doctors felt that electronic cigarettes are harmful to the user's health. Use of this product would increase the risk of cancer according to 73.1% of participants, the risk of cardiovascular disease according to 68.5% of participants, and the risk of chronic lung disease according to 79.2% of participants. The perception of e-cigarettes as harmful to the user's health was associated with the physicians' medical specialty (p=0.032). The recommendation of e-cigarettes as a smoking cessation tool was negatively correlated with addictology training (p=0.027)., Conclusions: Physicians' knowledge of electronic cigarettes is heterogeneous, reflecting the current lack of information and consensus.

Blood transfusion frequently consists in bringing blood components in patients presenting with global deficiency of cells or of certain factors allowing, i.e. hemostasis or oxygenation; transfusion is thus performed on a short period, or on a period that corresponds to the recovery of the bone marrow (that is deficient either quantitatively or qualitatively). In some other circumstances, patients must receive transfusions as the one treatment of their pathology; this can be for life, when the deficiency has a genetic origin, or episodically in the case of autoimmune disorders. Once hemotherapy is initiated, one must appreciate the balance between the benefits and the risks or overload, and adjust with subtractions and exchanges (of blood components). This paper presents examples of two cases: hemotherapy in sickle cell patients, and patients undergoing plasma exchange programs., (Copyright © 2015. Published by Elsevier Masson SAS.)

Objective: Maternal and fetal risk is often high during pregnancy in sickle cell disease. Our objective was to evaluate the benefits of a transfusion program adapted to each pregnant patient, either by red cell transfusion or by automated red cell exchange, in sickle cell patients with a history of serious obstetrical and/or sickling complications., Study Design: We managed 18 pregnancies in 14 patients (12 SS, 1 SC, 1 S/b-thalassemia), seven of whom had a history of one or more pregnancies, with severe maternofetal complications in nine out of 10 cases. The other seven patients were pregnant for the first time and were in care because of a history of severe sickling complications. The aim was to achieve a proportion of abnormal hemoglobin (hemoglobin S or S+C) below 50% and a hemoglobin level between 9 and 11 g/dL. The choice between transfusion and red cell exchange was made in the light of the hemoglobin level. Red cell exchange was done using a Fresenius Com. Tec blood cell separator. Patients had red cell exchange in 10 cases, and transfusions in five cases. In three cases, patients had successive transfusions and red cell exchange., Results: No serious maternal complication was observed. No fetal or perinatal death occurred. In one case, delivery was induced at 36 weeks of gestation because of fetal distress and hypotrophy., Conclusions: Our study suggests that women with severe sickle cell disease, even if they have a serious obstetrical history, can carry their pregnancy to term, without major obstetric complications, through a combination of early management by a multidisciplinary team and a suitable policy of prophylactic transfusion or automated red cell exchange.

The authors report a case of a young patient with a recent decrease in unilateral vision. He had homozygote sickle cell disease with multiple general complications. Fundus examination was normal apart from a mild alteration of the macular reflect in the left eye, but fluorescein angiography showed multiple arteriolar macular occlusions, explaining the decrease in vision in the left eye. After erythropheresis, vision acuity improved and fluorescein angiography showed reperfusion. This case suggests that transfusional exchange may improve acute macular ischemia secondary to sickle cell disease.

Objectives: The possibility of "community-acquired" viral infection has been suggested in alcoholics. In order to assess this hypothesis, we evaluated the prevalence of antibodies against hepatitis A virus, a oro-fecally transmitted virus, in heavy drinkers., Patients and Methods: We retrospectively studied 258 heavy drinkers, 188 males and 70 females, divided into sub-groups of increasing age, and compared them to 277 similarly classified blood donors., Results: The prevalence of serum anti-hepatitis A antibodies was significantly higher in alcoholics than in controls (64.7 vs 52.3%, P < 0.01). The difference was particularly marked in patients younger than 45 years old (56.2 vs 39.1%, P < 0.01). In the alcoholics, there was no correlation between the prevalence of anti-hepatitis A antibodies and the socioeconomic level, the quantity of alcohol ingested, or the severity of the underlying liver disease., Conclusion: These results suggest that alcoholism is, per se, a risk factor for viral infections.

In a prospective, non-randomized, pilot study, we evaluated the efficacy of hepatitis B virus (HBV) vaccination in inhibiting HBV replication of chronic hepatitis B. Fourteen consecutive chronic HBs antigen carriers received standard vaccination with three injections of the GenHevac B vaccine, one month apart. All the patients had active HBV replication with chronic hepatitis but not cirrhosis. They were compared to a historical group of 34 patients who fulfilled the same inclusion criteria. Over the 6-month follow-up period after the first injection, serum HBV DNA became undetectable in 3 patients (21.4%). Four additional patients (28.6%) showed a significant decrease in HBV replication. In 4 cases, the disappearance of or decrease in HBV DNA was preceded by an increase in transaminase activities, which was also observed in one patient who did not modify his viral replication. Vaccination was otherwise uneventful. By contrast, during a mean follow-up of 40 months, only 3 (9%) of the 34 unvaccinated patients who served as controls lost serum HBV DNA, giving a 6-month HBV DNA disappearance rate of 1%. In sum, vaccination appeared able to reduce or stop HBV replication in half of the chronic HBsAg carriers with chronic hepatitis. This additional therapeutic tool may enhance the rate of response to interferon-alpha therapy, which is dependent on the level of HBV replication. Thus, immunotherapy should be considered of potential importance for the treatment of HBV infection.

C18:2 omega 6/C18:3 omega 3 ratio was lowered in the diet of Elderly subjects. This was done by the replacement of usual sunflower oil by rapeseed oil or by supplementing soybean oil. This diet modification induced an increase of EPA (C20:5 omega 3) and DHA (C22:6 omega 3) in red cell phospholipids. The omega 6 fatty acids (C18:2 and C20:4) were slightly modified. Therefore, dietary C18:2 omega 6/C18:3 omega 3 ratio, seems to play an important role in the determination of membrane highly unsaturated fatty acid levels.

The significance of isolated anti-HBs antibodies in subjects not vaccinated against the hepatitis B virus (HBV) was investigated in 13 healthy blood donors. All were European and none had any risk factor for hepatitis B infection. Serological assays included HBV-DNA and anti-preS 2 antibody determinations which were all negative. After injection with hepatitis B vaccine (Hevac B), only one out of the 13 subjects exhibited an anamnestic response in favor of secondary immunization. Neutralization tests for serum anti-HBs antibody were positive in only 6 subjects. Our data suggest that in most cases isolated anti-HBs positivity does not correspond to true antibody; booster injection of HBV vaccine seems to be the best way of verifying that antibodies are really protective.

33 healthy men, 72 years old on average, ingested during five week: 2,4 g of Oenothera Biennis oil rich in PUFA. Before and after ingestion, platelet aggregation was measured according to the Born's photometric method, which divided the original group into two classes: "15" normal subjects (NAG) and "18" hyperagregated (HAG). The fatty acids contained in the serum were analysed by GLC. NAG liquid pattern did not show any difference after oil ingestion, as in HAG group, significant modifications were observed in palmitoleic, linoleic and linolenic fatty acid series. These observations probably correspond to a fundamental behavior difference, which might be related to desaturase activity reduction. Such a phenomenon would appear with ageing in some subjects. If this hypothesis is confirmed, the inclusion of the two methods of investigation described above would constitute a good approach for studying the enzymatic system activity in ageing.

This study had the two following purposes: to assess the age-related changes in the fluid and crystallized components of intelligence in subjects over age sixty five; to examine whether these age-related changes were linked to any biological, psychological and social factors. The sample was composed of 50 male subjects who were examined three times: in 1968, 1973 and 1977. At the beginning of the study, their age ranged from 60 to 79 years and they were all in good health. In the whole, their socio-economic level was high. At each wave of the study, these subjects were given the same battery of three mental tests: a vocabulary test, selected to assess crystallized intelligence; a perceptual test and a speeded digit coding test, both selected to assess fluid intelligence. Results show that the two components of intelligence have different aging trajectories over age sixty. On the vocabulary test, performances hold until an advanced age (about 75-80), then significantly decline. On the perceptual and digit coding tests, performances sharply and significantly decline with age, this decline looking approximately linear. Whatever the test used, individual differences in age-related changes in performance are found to be great. On vocabulary test, this variability is linked to two factors, independently of age: among subjects who have suffered from a cardio-arterial disease between wave 1 and wave 3, as well as in those who have not maintained an occupational activity, decline in performance is greater than in other subjects. On the two other tests, no factor was found to be significantly linked with change in performance between wave 1 and wave 3.