Inborn Errors of Immunity in Algerian Children and Adults: A Single-Center Experience Over a Period of 13 Years (2008–2021)

Background

Inborn errors of immunity (IEI) predispose patients to various infectious and non-infectious complications. Thanks to the development and expanding use of flow cytometry and increased awareness, the diagnostic rate of IEI has markedly increased in Algeria the last decade.

Aim

This study aimed to describe a large cohort of Algerian patients with probable IEI and to determine their clinical characteristics and outcomes.

Methods

We collected and analyzed retrospectively the demographic data, clinical manifestations, immunologic, genetic data, and outcome of Algerian IEI patients - diagnosed in the department of medical immunology of Beni Messous university hospital center, Algiers, from 2008 to 2021.

Results

Eight hundred and seven patients with IEI (482 males and 325 females) were enrolled, 9.7% of whom were adults. Consanguinity was reported in 50.3% of the cases and a positive family history in 32.34%. The medium age at disease onset was 8 months and at diagnosis was 36 months. The median delay in diagnosis was 16 months. Combined immunodeficiencies were the most frequent (33.8%), followed by antibody deficiencies (24.5%) and well-defined syndromes with immunodeficiency (24%). Among 287 patients tested for genetic disorders, 129 patients carried pathogenic mutations; 102 having biallelic variants mostly in a homozygous state (autosomal recessive disorders). The highest mortality rate was observed in patients with combined immunodeficiency (70.1%), especially in patients with severe combined immunodeficiency (SCID), Omenn syndrome, or Major Histocompatibility Complex (MHC) class II deficiency.

Conclusion

The spectrum of IEI in Algeria is similar to that seen in most countries of the Middle East and North Africa (MENA) region, notably regarding the frequency of autosomal recessive and/or combined immunodeficiencies.

Diagnostic and Predictive Contribution of Autoantibodies Screening in a Large Series of Patients With Primary Immunodeficiencies

Objectives

To evaluate the diagnostic and predictive contribution of autoantibodies screening in patients with primary immunodeficiencies (PIDs).

Methods

In the present study, PID patients and healthy controls have been screened for 54 different autoantibodies. The results of autoantibodies screening in PID patients were correlated to the presence of autoimmune diseases.

Results

A total of 299 PID patients were included in this study with a predominance of antibody deficiencies (27.8%) followed by immunodeficiencies affecting cellular and humoral immunity (26.1%) and complement deficiencies (22.7%). Autoimmune manifestations were present in 82 (27.4%) patients. Autoimmune cytopenia (10.4%) was the most common autoimmune disease followed by gastrointestinal disorders (10.0%), rheumatologic diseases (3.7%), and endocrine disorders (3.3%). Autoantibodies were found in 32.4% of PID patients and 15.8% of healthy controls (P < 0.0005). Anti-nuclear antibodies (ANA) (10.0%), transglutaminase antibody (TGA) (8.4%), RBC antibodies (6.7%), anti-smooth muscle antibody (ASMA) (5.4%), and ASCA (5.0%) were the most common autoantibodies in our series. Sixty-seven out of the 82 patients with autoimmune manifestations (81.7%) were positive for one or more autoantibodies. Eleven out of the 14 patients (78.6%) with immune thrombocytopenia had positive platelet-bound IgM. The frequencies of ASCA and ANCA among patients with IBD were 47.4% and 21.0% respectively. All patients with celiac disease had TGA-IgA, while six out of the 11 patients with rheumatologic diseases had ANA (54.5%). Almost one third of patients (30/97) with positive autoantibodies had no autoimmune manifestations. ANA, rheumatoid factor, ASMA, anti-phospholipid antibodies and ANCA were often detected while specific AID was absent. Despite the low positive predictive value of TGA-IgA and ASCA for celiac disease and inflammatory bowel disease respectively, screening for these antibodies identified undiagnosed disease in four patients with positive TGA-IgA and two others with positive ASCA.

Conclusion

The present study provides valuable information about the frequency and the diagnostic/predictive value of a large panel of autoantibodies in PIDs. Given the frequent association of some AIDs with certain PIDs, screening for corresponding autoantibodies would be recommended. However, positivity for autoantibodies should be interpreted with caution in patients with PIDs due to their low positive predictive value.

Prevalence of depression in Tunisian general population

Introduction

Depression is a major burden for the health-care system worldwide.

Objective

To identify prevalence and severity of depression in Tunisian general population and define socoiodemographic characteristics of screened positive to depression participants.

Method

We undertook a cross-sectional and descriptive study. A total of 134 participants, representative of the Tunisian general population, were enrolled. Age, gender, and educational level were the major criteria for representativeness. Depression was assessed with the Patient Health Questionnaire (PHQ-9).

Results

The cut-off score was 10. The prevalence of depression was 13.4%. There were no statistical difference in gender, education and age for the prevalence of depression.

Conclusion

The World Health Organization ranks depression as the fourth leading cause of disability worldwide. Thus, the detection of depression and the dissemination of treatment in the general population are very important to reduce the burden of the disease.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Validation of the Tunisian version of the patient health questionnaire (PHQ-9)

Introduction

The PHQ-9 has been recommended as the best available screening and case-finding instrument for primary care based on its brevity, and ability to inform the clinicians on both depression severity and diagnostic criteria.

Objective

Our study evaluated the reliability and the validity of the Tunisian version of the PHQ-9 in detecting major depression in general population.

Method

We undertook a cross-sectional and analytical study. A total of 134 participants, representative of the Tunisian general population, were enrolled. The PHQ-9 was validated against the HAD reference standard. The types of validity determined for the PHQ-9 in this study were: translation validity, internal reliability and criterion validity.

Results

Test-Retest reliability was determined by intraclass correlation. This scale is stable over 2 weeks (ICC = 0.97). The Tunisian version of the PHQ-9 was found to have good internal reliability (Cronbach's alpha = 0.84). As for criterion validity of the PHQ-9, the Pearson's correlation coefficient between the PHQ-9 and HAD was 0.94 and the Spearman's correlation coefficient was 0.81. This indicated a positive association of good strength between the two instruments. A cut-off score of 10 or higher on the PHQ-9 had a sensitivity of 86.2 and a specificity of 83.8. The VPP was 0.6 and the VPN was 0.9.

Conclusion

The Tunisan version of the PHQ-9 has several potential advantages. It was found to be a valid and reliable casefinding instrument for detecting depression in general population.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Clinical and socio-demographic profile of bipolar I disorder patients

Introduction

The bipolar disorder (BD) is a chronic and severe disease which diagnosis and treatment are still raising the issues.

Aims

To show a potential clinical and socio-demographic profile in BD patients.

Objective

We hypothesized that BD patients have a particular clinical and socio-demographic characteristics.

Methods

This was a descriptive and retrospective study which assesses 49 BD's outpatients. The diagnosis was accorded to DSM-IV criteria. The enrollment was conducted from January 2010 to August 2015. The socio-demographic and clinical data were collected by a preestablished railing.

Results

The mean age was 39.7 years with a sex ratio of 1.33. Six patients (12.2%) lived in urban zones and 61% (n = 30) patients have a lowly socioeconomic conditions. Celibacy was the prevailing civil status in 57.1% (n = 28) among which 17 lived in family home. Thirty-four (69.4%) patients were unemployed.

A primary school level was found in 34.7% of the cases (n = 17). Nineteen patients (38.8%) were schooled until the secondary level and 9 patients (18.4%) followed a university program.

Addiction to smoking was found at 26 patients (53%) whose half of them had moreover an alcoholic poisoning. The mean age at the diagnosis was 35.6 years with an inaugural manic episode in 63.4% (n = 31) of the cases. The average number of relapse was 1.23 and the mean duration of follow-up was 3.2 years.

Conclusion

The knowledge of the profile of the consultants, their socio-demographic and clinical characteristics would allow to adapt the offer of care to the request.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

CHARACTERIZATION AND BIOCONTROL POTENT OF STREPTOMYCES SP. ISOLATED FROM THE RHIZOSPHERE OF ONONIS ANGUSTISSIMA LAM

A total of 40 actinomycetes isolated from rhizosphere soils of Ononis angustissima Lam. were in vitro tested for their antagonism against deferent pathogenic microorganisms by streak assay. Among the isolates, four (21, 2A26, 1B10 and 2C34) present a potent antagonism against both pathogenic bacteria and fungi, they were selected, identified by 16S rDNA sequence analysis and phenotypic properties, and tested for their antimicrobial activity as well as their biocontrol potential against Chickpea (Cicer arietinum L.) pathogenic fungus (Fusarium oxysporum). Cultural characteristic studies strongly suggested that these strains belong to the genus Streptomyces. The four Streptomyces sp., solubilize phosphate and produce extracellular fungal cell-wall degrading enzymes chitinase and protease, as well as a marked production of acid-β-indole acetic (AIA). The nucleotide sequence of the 16S rRNA gene of Streptomyces sp. strains 21, 2A26, 1B10 and 2C34 exhibited close similarity (62-75%) with Streptomyces parvulus MARS 16S rRNA genes. The inhibition was higher against fungi and Gram+ bacteria, while Gram- bacteria were less inhibited. The growth of the plant pathogenic fungus Fusarium oxysporum was considerably inhibited in the presence of the strains 21, 2A26, 1B10 and 2C34 culture supernatant. These studies revealed that the presence of the Streptomyces strains in the soil significantly promoted the growth of the Chickpea plants. These results indicate that the Streptomyces strains isolated for rhizosphere from Ononis angustissima Lam. growing in arid conditions in southern Algeria (Sahara) could be an interesting source for antimicrobial bioactive substances and as biocontrol agents.

A PLAUSIBLE ROLE FOR POLLEN-RESIDING MOLDS IN AGRICULTURAL PURPOSES

Pollen microbial content of 15 samples was investigated. Pollen was collected by honeybees. Total aerobic mesophilic count ranged from 3.00 to 5.48 Log CFU/g. Total mold and yeast count ranged from 2.3 to 6.99 Log CFU/g. Selected strains of isolated molds from pollen samples were characterized by conventional methods. Potent phytopathogenic and food spoilage species such as Penicillium sp., Alternaria alternata, Alternaria sp., Cladosporium werneckii, Mucor hiemalis, Rhizomucor pusillus, Aspergillus flavus, Aspergillus niger, Drechslera tritici-repentis, Verticillium albo-atrum, and Aspergillus alliaceus were recovered. Other fungal species with valuable biotechnological and plant diseases control purposes were isolated. They were characterized as Geotrichum candidum, Monilia sitophilia, and Sepedonium chrysospermum. Animal pathogenic molds were also isolated. Bee pollen may be considered as a source for a highly diverse fungal flora with different applications.

Clinical assessment of treatments for prolonged bleeding in users of Norplant implants

The effectiveness of three drugs in controlling prolonged bleeding in the first year of NORPLANT implants use was tested. The drugs were levonorgestrel (L-Ng, 0.03 mg twice a day for 20 days), ethinylestradiol (EE, 0.05 mg per day for 20 days) and ibuprofen (Ib, 800 mg three times a day for 5 days) and were given orally. A control group received a placebo (PL, one pill of lactose for 20 days). Treatment should start each time a woman experienced eight consecutive days of bleeding or spotting. The 183 volunteers were not aware of the drug administered. A daily record of bleeding and spotting and of treatment intake was maintained. One-hundred-forty women completed the study period; 60 never used the prescribed treatment. Women treated with the three test drugs had significantly fewer bleeding and spotting days during the treated month and also throughout the study year than women using the placebo. The mean number of bleeding plus spotting days per actually treated subject in the first year was 77, 94, 101 and 129 days for the EE, Ib, L-Ng and PL groups, respectively. The administration of EE might help in the management of prolonged bleeding during the first year of NORPLANT implants use.

The implication of opiates in the glucocorticoid-mediated inhibition of LH secretion in rats

The present study was designed to test the effect of acute administration of dexamethasone on the postcastration and gonadotrophin-releasing hormone (GnRH)-induced rise of LH, and to examine whether the inhibitory action of glucocorticoids on LH secretion was mediated by the opioid system. Rats were castrated and injected 10-10.5 h later in a first set of experiments with saline, dexamethasone (250 micrograms/rat), nalmefene (2 mg/kg body weight) or nalmefene plus dexamethasone. The response to GnRH was tested 11 h after castration (time 0) in all groups. Dexamethasone caused a significant (P less than 0.005) decrease in basal serum concentrations of LH, while saline and nalmefene did not induce any change. The administration of dexamethasone preceded by nalmefene increased basal concentrations of LH (1.6 times), with an effect significantly greater than that of dexamethasone (P less than 0.001), nalmefene (P less than 0.05) or saline (P less than 0.005) alone. GnRH induced a significant (P less than 0.001) increase in serum concentrations of LH in all groups. In a second set of experiments, administration of naloxone (2 mg/kg body weight) increased LH levels (P less than 0.05) and similarly reversed the inhibitory effect of dexamethasone on LH.(ABSTRACT TRUNCATED AT 250 WORDS)

Recovery of fertility after use of the levonorgestrel 20 mcg/d or Copper T 380 Ag intrauterine device

Following use of either the Levonorgestrel 20 mcg/day or the TCu 380 Ag IUD in a randomized comparative study, 110 women stopped contracepting to have planned pregnancies. Pregnancy rates and recovery of fertility have been assessed. Age at acceptance, duration of use, parity and intervals between last pregnancy and IUD insertion or removal were similar for both groups. Life table pregnancy rates at one year were higher than 90 per cent for both device groups; but because some women quickly changed their minds or had been at risk of pregnancy only a short time before the analysis date, only 60.9 percent had actually become pregnant. Median time to planned pregnancy was 3 months for the TCu 380 Ag group and 4 months for the Levonorgestrel 20 group. Neither duration of use nor age at insertion or age at termination affected the pregnancy rates significantly.