Misdiagnosis and therapeutic impasse in psychiatry

Introduction

We frequently receive patients with atypical psychiatric symptoms admitted in our department after consulting other psychiatrists and triying several treatments.

Objectives

To highlight the factors of misdiagnosis in patients of our department.

Methods

We recruited 70 patients during their appointment or during their hospital admission in our department between March and April 2021. We collected the patients’ socio-demographic and clinical data using a pre-designed questionnaire.

Results

Patients were aged between 17 and 68 years with a sex ratio (M/F) of 1. Mood disorders accounted for 24.6% of disorders (N=17) whereas schizophrenia 66.7% (N=46). Patients resided in urban areas in 88.6% of cases (N=69). The average number of hospitalizations was 2.7 with extremes ranging from 0 to 14. The average time between the onset of the symptoms and the first consultation was 1 year. The mean time from onset to hospitalization was 4.37 years. The rate of consulting a psychiatrist prior to admission was 42.8%. The diagnosis was corrected during the follow-up of the patients in 24.3% of cases. Conventional neuroleptics were prescribed as first-line treatment in 42.85% of cases. Due to poor tolerance or ineffectiveness of the treatment, 31.42% of patients had to change treatment.

Conclusions

Patients, who were desperate to find an adequate treatment for their disorders, put a lot of hope in the Razi psychiatric hospital. But after several years of evolution of their disease, we are faced with a therapeutic impasse. Raising awareness of mental illnesses is necessary for an early and adequate treatment.

Disclosure

No significant relationships.

Women’s access to mental health care in Tunisia

Introduction

Tunisia is viewed as an advanced country in terms of women’s rights in the Arab world. However, women are more exposed than men to many specific risk factors which greatly contribute to threaten their mental health.

Objectives

The main objective of this study was to find out the sociodemographic and clinical profiles of women admitted in Razi psychiatric hospital and their access to mental health services.

Methods

A cross sectional and descriptive survey was conducted between March and April 2021 in the department of psychiatry D of Razi Hospital including 40 female inpatients.

Results

The majority of patients had low (37.1%) to moderate (61.9%) socio economic status, with primary education (40%), secondary education (20%) and higher education (28.6%). The majority was unemployed (68.8%). A significant difference was observed between adherence to treatment and family support (p=0.04). It was mainly the father or the husband who was taking care of the patient in 50% of cases. The first psychiatric consultation was 2.68 years after having symptoms. Hospitalization was about 4.94 years later. Twenty five percent of them have seen a tradipractioner before consulting. About 46.87% of patients had conflicts with a member of her family and 15.62% of them were victims of either domestic or family violence. The main diagnoses were mood disorders (31.4%) and schizophrenia (42.9%) Time between symptoms onset and hospitalisation was significantly associated with socioeconomic status (p=0.047) and cultural beliefs (p=0.026).

Conclusions

The protection of women’s mental health is not only a medical challenge but also a cultural and political one.

Disclosure

No significant relationships.

Role of nurses in the initiation and the monitoring of Lithium

Introduction

Lithium is the oldest known treatment of bipolar disorders and remains the gold standard. Nevertheless, it remains difficult to handle, largely due to its narrow therapeutic index and its long-term side effects. Thus, it requires special initiation and monitoring measures.

Objectives

This study aims to assess nurses’ knowledge and attitudes regarding lithium. A protocol on Lithium initiation and monitoring will be established.

Methods

This is a descriptive study including 20 nurses in a psychiatry department conducted from January to May 2021 based on an self-assessment questionnaire that was established to assess nurses’ knowledge about Lithium, its side effects, initiation and monitoring.

Results

None of the recruited nurses had any training regarding the use of lithium. The vast majority of subject (85%) said that lithium’s dosage must be individualized and adaptable to each patient throughout a specific blood test. 90% recognized renal failure as the most common contraindication of lithium. Complete Blood Count (CBC), and renal check-up were the only tests recognized as necessary by all the sample subjects. 90% answered that lithium is toxic and 65% answered that it is fatal. In case of toxicity by lithium all subjects (100%) agreed to call the responsible doctor of the patient, 25% of them chose it as a unique measure and 75% thought it was necessary to stop the lithium immediately as well.

Conclusions

Lithium is considered as a double-edged sword largely due to its narrow therapeutic index. Nevertheless, nurses are undertrained when it comes to its use and manipulation.

Disclosure

No significant relationships.

Post-ictal psychosis syndrome : A case report

Introduction

Psychiatric comorbidity is prevalent among patients with epilepsy. Post-ictal psychosis syndrome (PIP) is a recent entity important to know. It belongs to the group of epileptic psychoses. The clinical presentation is often atypical, and symptoms are usually related to seizures.

Objectives

This work aimed to study the particularities of PIP.

Methods

It is a case report of PIP, involving a patient hospitalized in psychiatry department.

Results

We report the case of a 45-year-old woman, with medical history of generalized epilepsy which was stabilized under antiepileptic treatment (phenobarbital 150 mg/day). The patient was hospitalized for psychomotor instability and inconsistent speech after having experienced a generalized tonic-clonic seizure in the context of discontinuation of treatment. Psychiatric assessment revealed a hostility, a reluctance , a persecution delirium and auditory and visual hallucinations. A series of examinations have been carried out ; Neurological examination revealed no anomaly , a computed Tomography Scan of the Brain was normal. A lombar puncture was normal. A covid-19 infection was eliminated. The usual antiepileptic medication was reintroduced to the patient (Phenobarbital 150 mg/day),in association to benzodiazepines (clonazepam 4 mg/day). After 72 hours of treatment, psychiatric symptoms improved. The patient returned to its baseline condition after 7 days. A similar episode was reported two months earlier in the same circumstances with a similar symptomatology and a spontaneous resolution within 7 days.

Conclusions

PPI syndrome, regardless of its good short-term prognosis, can potentially evolve into other psychiatric disorders of less good prognosis. Thus, this syndrome should be managed in collaboration with neurology and psychiatry.

Disclosure

No significant relationships.

Spectrum of acute hepatitis and its clinical outcome in a central region in Tunisia

Introduction

given the lack of studies on acute hepatitis (AH) in Tunisia, we carried out this study to find the etiological spectrum and clinical profile of AH and to investigate the impact of viral etiology on the outcomes of AH.

Methods

retrospective descriptive study collecting all patients with AH from 2010 to 2017. The data were compared between two groups (viral AH and non-viral AH).

Results

one hundred and three patient´s files were included. The average age of our patients was 30.15 years. An etiology was found in 92 patients (89.3%). The viral etiology was found in 70 patients (76.1%). Hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV) and cytomegalovirus (CMV) were in the cause in 52, 16, 1 and 1 patient respectively. Elsewhere, it was toxic hepatitis in 10 patients (10.9%) including 7 of drug-related AH. Budd-Chiari syndrome and autoimmune hepatitis with acute onset were reported in 3 (3.3%) and 7 (7.6%) patients, respectively. Patients with viral AH were younger than those with non-viral AH (p = 10-³). There was more recourse to hospitalization for non-viral AH. Patients with viral AH had a higher mean aminotransferase (ALT) level than those with non-viral AH. The liver damage was more severe in the non-viral AH group with lower PT. There was more severe form, more transition to chronicity and more deaths in the non-viral AH group. Conclusion: the results found in our study concerning the distribution of the etiologies of AH as well as their evolutionary aspects are consistent with the data in the literature.

Occurrence of Hypopituitarism in Tunisian Turner Syndrome patients: familial versus sporadic cases

OBJECTIVE

To explore unusual association between Turner Syndrome (TS) and Hypopituitarism in a Tunisian cohort.

METHODS

We reported 6 patients with TS associated to Hypopituitarism, including three familial cases except the fourth sister who showed only a TS phenotype. Biochemical analysis, resonance magnetic imaging and cytogenetic analyses were performed.

RESULTS

The average age of our patients was 17.2 years (11-31 years). They were all referred for short stature and pubertal delay, except for the fourth sister who presented spontaneous puberty with the integrity of the pituitary axis and the presence of an X ring chromosome. Karyotype analysis showed monosomy in 3 cases and a mosaic TS in the 3 remaining cases, including one patient with abnormal X chromosome structure. Somatotropic and corticotropic deficiencies were confirmed in 2 sporadic cases while the gonadotropic and thyrotropic axes were spared. In contrast; familial cases were consistently affected by the integrity of the corticotropic axis. MRI showed pituitary hypoplasia in all familial cases and pituitary stalk interruption syndrome in only one sporadic case. No correlation was found between the chromosome formula and the anterior pituitary involvement.

CONCLUSION

Co-segregation of congenital Hypopituitarism with pituitary hypoplasia and X chromosome aberrations could imply a molecular anomaly of transcription factors responsible for the differentiation and development of pituitary cells such as PROP1, POUF1, Hesx1, Lhx3, Lhx4. The etiopathogenic link between X chromosome abnormalities and the occurrence of Hypopituitarism remains unclear; however, the progress of molecular biology may clarify the interrelation between transcription factors and sex chromosome segregation abnormalities.

AB0520 PUBIC SYMPHYSIS INVOLVEMENT IN NON-RADIOGRAPHIC SPONDYLARTHRITIS

Background:

Structural change within pubic symphysis (PS) occurs in 20–25% of patients with spondylarthritis (SpA). It occurs in all developmental stages, even in the early stages of the disease. Changes in the symphysis can sometimes precede spine and sacroiliac involvement. Radiological findings in PS were poorly described in the SpA, especially on its non-radiographic form (nr-axSpA).

Objectives:

We aimed in this study to evaluate pubic symphyseal features in patients with a confirmed diagnosis of nr-axSpA and to assess the correlation of these changes with clinical and imaging features of nr-axSpA in these patients. We also focused on the relationship between parity and radiographic changes in pubic symphysis (PS).

Methods:

We retrospectively reviewed the data of 40 patients diagnosed with nr-axSpA according to the ASAS criteria. Radiological-morphological changes of PS were assessed in pelvic radiography by two distinct rheumatologists. Grading symphysial involvement was made as follow: scores ranged from 0-4 per reading: grade 0 = normal; grade 1 = subtle irregularity and/or subchondral sclerosis, grade 2 = clear erosions, 3 = marked sclerosis, grade 4 = ankylosis.

For all patients, we calculated the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the BASRI (Bath Ankylosing Spondylitis Radiology Index).

For all patients, we recorded the sacroiliac changes showed by the previous pelvic radiography and/or the pelvic scanner and/or by magnetic resonance imaging (MRI).

Results:

We enrolled forty patients with a sex-ratio H/F=1/3. Mean age of patients at diagnosis was 39,9 +/- 10,8 [17-59]. Forty percent of patients had peripheral enthesitis, and 45% had peripheral arthritis. BASDAI mean score was 4,63 +/- 0,9 [0-8,6]. HLA B-27 was present in 32,3% of cases. We noted radiographic changes in PS in 37,5% (15 patients): grade 1 (n=1), grade 2 (n=10), grade 3 (n=3) and grade 4 (n=1). There was not a significant difference between the sex group (p=0,85). A comparison of 2 groups (women with 3 children or more and women with less than 3 children) concluded that childbirth did not modify PS changes (p=0,9). Also, PS changes did not differ with age (p=0,5). There was no correlation between the BASRI value with the presence of PS changes nor with its grades (p=0,5 and p=0,89, respectively). Also, disease activity did not influence the PS involvement (p=0,4). Radiological findings in PS was not correlated with the sacroiliac features found on MRI or pelvic CT scan (p=0,59 and p=0,1).

Conclusion:

In SpA criteria, PS changes were not considered. It can be an additional help in making the diagnosis. Interestingly, pubic symphysis may exist without sacroiliitis.

Disclosure of Interests:

None declared.

Clozapine-induced parotitis: A case study

Introduction

Clozapine is the drug of choice for patients with an unsatisfactory response to classic antipsychotic treatment. Little is known about the involvement of clozapine in the development of parotid disease.

Objectives

Identify the clinical characteristics of Clozapine-induced parotitis through a case and literature review.

Methods

We report the case of a patient with a refractory schizoaffective disorder, bipolar type and who developed recurrent parotitis while taking clozapine. We conducted a literature review based on a PubMed search of articles published on this subject with the following keywords: ‘parotitis clozapine’.

Results

Miss W., 34 years old, suffers from a severe schizoaffective disorder that has been diagnosed for several years. She has received various psychotropic medications. She suffered from frequent relapses that required recurrent hospital admissions. One year ago, a diagnosis of treatment-resistant schizoaffective disorder was made. The decision to introduce clozapine, associated with mood stabilizer treatment, was made on the basis of her treatment refractory symptoms. She experienced considerable sialorrhea after beginning clozapine treatment. Miss W. developed bilateral recurrent swelling over both temporal-mandibular areas after 6 months of treatment. It often appears after eating and lasts from 4 to 6 hours. There was no change in white blood cell count and she was afebrile. An otolaryngologist was consulted and a diagnosis of clozapine-induced parotitis was suggested. A spasmolytic and an anticholinergic treatment were prescribed and clozapine was continued.

Conclusions

This iatrogenic effect of clozapine must be recognized by clinicians in order to be better prevented.

Lorazepam causing drug-induced liver injury : Rare entity

Introduction

Lorazepam is a benzodiazepine derivative that is globally used for the therapy of anxiety and insomnia.

Objectives

The objective of our work was to show that Lorazepam can be a cause of unexpected liver injury even though it is a rare entity.

Methods

We reported the case of a patient who had a Drug-Induced Liver Injury (DILI) under Lorazepam. We performed a literature review based on a PubMed search with the following keywords: “Lorazepam,DILI”.

Results

A 20 year-old-Tunisian woman was hospitalized in the psychiatry department of the hospital of Nabeul in Tunisia for a brief psychotic episode.She had a DILI under Olanzapine, Chlorpromazine and Lorazepam, which conducted us to interrupt her treatments except for the Lorazepam(5mg/day). The hepatic tests went back to normal even under Lorazepam. Few days later, the liver enzymes increased again to reach very high levels. Extensive workup was negative for other causes of liver injury, including viral hepatitis A, B, C and E.; capillary electrophoresis of serum proteins was normal; Exhaustive immunological tests were performed searching for auto immune hepatitis(anti-smooth muscle antibodies, anti-LKM1, anti-LC1, anti-SLA/LP) primary biliary cholangitis(anti-mitochondrial antibodies, anti-GP210, anti-sp100) and other antibodies like antinuclear antibodies were negative. Liver biopsy showed polymorphic inflammatory infiltrate including some eosinophilic polynuclear cells and rare vaguely epitheloid macrophages, with necrotico-inflammatory foci in the lobules, all of which were consistent with DILI. Lorazepam was discontinued and within 10 days her liver enzymes decreased and completely normalized.

Conclusions

Lorazepam, with an unknown action mechanism, can be a cause of DILI.

Disclosure

No significant relationships.

AB0307 DOES FCGR2A, FCGR3A AND FCGR3B POLYMORPHISM CAN PREDICT ANTI-DRUG ANTIBODIES APPARITION IN RHEUMATOID ARTHRITIS PATIENTS TREATED WITH TNF-BLOCKERS?

Background:

Fc gamma receptors (FcγRs) play a major role in the regulation of humoral immune responses. Single-nucleotide polymorphisms (SNPs) of FCGR2A and FCGR3A and FCGR3B can impact the expression level, IgG affinity and function of the CD32 and CD16 FcγRs in response to their engagement by the Fc fragment of IgG. It was described in patient treated for rheumatoid arthritis (RA), that such a polymorphism may influence patients response to TNF-blockers.

Objectives:

In this study, we aimed to investigate whether the FCGR2A H131R (rs1801274), FCGR3A F158V (rs396991), and FCGR3B NA1/NA2 polymorphisms can be involved in the genesis of anti-drug-antibody ADAb to anti-TNF therapy in RA patients under etanercept (ETA), adalimumab (ADL) and infliximab (INF).

Methods:

We included 47 patients treated for RA under TNF-blockers. To assess the association between the FCGR2A H131R (rs1801274), FCGR3A F158V (rs396991), and FCGR3B NA1/NA2 polymorphisms and immunogenicity of TNF-blockers, we used allele contrast, the recessive model, the dominant model, and the homozygote contrast. Quantitative measurements of the ADAbs was carried out by a commercial enzyme-linked immunosorbent assay (ELISA) kit (Promonitor)®after 6 months of treatment.

Results:

We involved 18 patients treated with ETA, 13 patients with ADL and 16 under INF. None of the patients under ETA has developed ADAb and respectively 1 and 7 patients developed immunogenicity with ADL and INF. We excluded patients under ETA from statistical study since they didn’t develop ADAb.

A significant association was revealed between FCGR2A H131R polymorphism and immunogenicity of INF and ADL (table 1).

Table 1.

Association between FCGR2A polymorphism and immunogenicity to INF and ADL

FCGR2A association with ADAb (n=29, crude analysis)GenotypeADAb=0ADAb=1OR (95% CI)P-valueH/H1 (4.8%)3 (37.5%)1.000.031H/R-R/R20 (95.2%)5 (62.5%)0.08 (0.01-0.98)

There weren’t significant associations between ADAb’s development and FCGR3A F158V and FCGR3B NA1/NA2 polymorphism.

Conclusion:

FCGR2A R allele carriers show less susceptibility to develop ADAb to ADL and INF with follow-up times of 6 months. Our results provide an explanation for controversies in the relationships between FCGR2A H131R polymorphism and TNF-blockers response. Further studies with larger population of RA patients should be undertaken to confirm this hypothesis.

References:

None

Disclosure of Interests:

None declared

AB0945 CONTRIBUTION OF MICROBIOLOGICAL AND ANATOMOPATHOLOGICAL EXAMINATIONS IN THE DIAGNOSIS OF SPONTANEOUS PYOGENIC SPONDYLODISCITIS IN ADULTS

Background:

Pyogenic spondylodiscitis (SPD) is a serious infection of an intervertebral disc and/or adjacent vertebrae, that remains a topical problem in rheumatological practice. Early diagnosis and treatment are the only guarantees of a favorable outcome. Clinicians must strive to isolate the responsible bacteria in order to adapt the treatment, and thus reduce the risk of resistance and complications due to SPD itself, but also to the multiplication of probabilistic treatments.

Objectives:

Our aim was to study the contribution of the different microbiological and anatomopathological examinations in the diagnosis of pyogenic SPD.

Methods:

It was a descriptive study in a single rheumatology department. Data were collected retrospectively from observations of patients hospitalized in the past 20 years who have been diagnosed with pyogenic SPD. We excluded cases of tuberculous and brucellar SPD from our study because of their completely different histological and microbiological profiles.

Results:

Twenty-two cases of pyogenic SPD were collected (14M/ 8F). The mean age of the population was 55.9 years [29,80]. A bacteriological survey including at least one cytobacteriological examination of the urine (CBEU), chest X-rays and blood cultures allowed the identification of the bacteria in 16 cases (73%). The most common site were bacteria was identified was blood culture in 7 cases, skin sample and urine collection in 2 cases each. Disco-vertebral puncture and biopsy (DVPB) was performed in 19 patients when there was no bacteria identification and/or when diagnosis of infectious SPD persisted doubtful. On histopathological examination, were described: an infiltrate and/or inflammatory changes without specificity signs in 7 patients and an appearance of chronic pyogenic SPD very likely in 12 patients. Bacteriological study of DVPB fluid or paravertebral abscesses sample helped to isolate bacteria in 4 patients. DVPB or abscesses puncture were contributing by histological and/or bacteriological examination in 12 patients (63%).

Infecting bacteria was identified in 14 patients (64%). Gram-negative bacilli (GNB) and staphylococcus aureus were the most frequent germs (7 cases each) including 2 cases of co-infection. GNBs were represented by: Escherichia Coli and Enterobacter Cloacae in 2 cases each, Proteus Mirabilis, Serratia Marcescens and Klebsiella oxytoca in 1 case each. Clostridium clostridioforme and Lactococcus cremoris were isolated in 1 case each. For patients whose etiological investigation remained negative, SPD diagnosis was retained based on imaging (MRI) guided by anamnestic, clinico-biological and histopathological arguments.

Conclusion:

SPD is a rare condition that needs to be treated rapidly. Once the diagnosis is suspected, bacteria must be isolated before starting any antibiotic therapy. Simple and non-invasive exams as blood cultures, CBUE and chest rays, should be undertaken first. In fact, these simple exams allowed a germ identification in 73% cases in our study. If doubt persist, DVPB could be contributive to the diagnosis.

References:

None

Disclosure of Interests:

None declared

Sleep disorders, depression and anxiety among medicine university students in Sfax

Introduction

Sleep symptoms, depression and anxiety often coexist and tertiary students are a population group that are increasingly recognised to be at risk. However the rates of these conditions in the tunisian population are poorly understood.

Aim

The aim of this study was to evaluate sleep quality among medicine students during exam periods and identify correlations with anxiety and depression.

Methods

This is a descriptive and analytical cross-sectional study. It involved students of medicine University of Sfax during the period of exams. Each student filled out demographic questionnaire, the Pittsburgh Sleep Quality Index (PSQI) to assess the quality of sleep and Hospital Anxiety and Depression scale (HAD) to screen for anxiety and depressive disorders.

Results

The average age was 22.27 years. The sex ratio M/F was 0.66. The students were single in 96.7% of cases. The average score of PSQI was 6.67 ± 3.23. According to the PSQI, 53.3% of students had poor sleep quality. The anxiety score ranged from 0 to 7 with an average of 8.37. The depression score ranged from 0 to 16 with an average of 7.47. Anxiety and depressive symptoms were present in 26.7% of students. The PSQI score was significantly correlated with anxiety (p <0.01) and depression scores (P = 0.019).

Conclusion

Anxiety and depressive symptoms are common among students during exam periods. They are associated with poor quality sleep. The establishment of a helpline for students during exam time, with psychologists and psychiatrists, would help them better manage this difficult period.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Screening for depressive symptoms among adolescent consulting in emergency

Introduction

Amongst adolescents, depression is a common mental health problem. Adolescent depression is associated with distress, functional impairment and difficulties in relationships with peers and family members. Depressive symptoms, even if sub-threshold to meet diagnostic criteria for a depressive disorder, are also risk factors for these difficulties. Adolescents rarely consult for their psychological distress. Emergency departments, which are often used by adolescents in this context, constitute a privileged place to detect this suffering.

Objectives

The objective of this study was to estimate the prevalence and correlates of psychological distress among adolescents seen in emergency department.

Methods

Our study was a transversal type, descriptive and analytic. It was conducted with 106 adolescents consulting in emergency department. All adolescents completed a sociodemographic data and the Adolescent Depression Rating Scale (ADRS), a screening questionnaire for depression.

Results

The study included 106 adolescents. All of them consult for a somatic complain and none of them goes to the emergency department for a psychiatric reason. The mean age was 16.34 ± 2.54 (12→19 years). Sex ratio (♂/♀) = 0.89. The ADRS score was considered normal (score < 4) for 54.7% of the sample (n = 58) and 45.3% of adolescents (n = 48) had depressive symptoms (score ≥ 4). Depression was significantly correlated to bad school results (P = 10−3), tobacco use (P = 0.014), personal psychiatric history (P = 10−3) and family problems (P = 10−3).

Conclusion

Depressive symptoms are frequent among adolescents. Their consultations within emergency department provide a potential opportunity for their identification and for signposting to appropriate specialist services.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Body shape perception among obese Tunisian women

Introduction

In today's societies, pressures from the idea of thinness are omnipresent and lead to a corporal dissatisfaction with an excessive preoccupation of the body's image. Obese persons are often targets of stigmatization and are vulnerable to negative feeling about their physical appearance.

Aims

To evaluate the worries towards the weight and the shape of the body among obese women.

Methods

Our study was a transversal study, descriptive and analytic. A total of 42 obese women were included. Obesity was defined by body mass index (BMI) ≥ 30 and divided into 3 classes: class I: moderate obesity (30 ≤ BMI ≤ 34.9); class II: severe obesity (35 ≤ BMI ≤ 39.9); class III: morbid obesity (BMI≥40). Patients were studied by mean of body shape questionnaire (BSQ-34) (Considering score BSQ < 80 lack of altered body image perception and score > 140 excessive preoccupation).

Results

The mean age of participants was 33.6 years. The average BMI was 37.42 kg/m2 (30.45–56.26 kg/m2). Third (35%) of women had a high educational level, 41.4% were inactive, and 70.8% had an average socioeconomic level.

The average BSQ score was 108.31 (47–188). The majority of women (78.1%) had excessive preoccupation about their body image. The BSQ score was correlated to morbid obesity (P = 0.014). Women aged between 20 and 3 years were significantly more preoccupied about their body image (P = 0.046).

Conclusion

Majority of obese women were preoccupied about their body image. Young women and those having morbid obesity seemed more preoccupied about their body image.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Sexual dysfunction in obese women

Introduction

The increasing prevalence of obesity represents a major public health problem, with can effect on physical and emotional well-being and psychosocial function. Somatic and psychological dysfunctions, such as infertility, osteoarthritis, social disabilities caused by stigmatization, sleeping problems or apnea, are also known to follow obesity. Sexual dysfunction (SD) may also be related to obesity, but is rarely mentioned, and may cause concern for the affected individual and partner, constituting a great problem.

Objectives

The aim of this study was to identify the frequency of SD among obese women.

Methods

Our study concerned 42 obese married women consulting in endocrinology department. Obesity was defined by body mass index (BMI) ≥30. All participants assessed a sociodemographic data and the “Female Sexual Function Index” (FSFI). FSFI is a 19-item multidimensional self-reporting measure that quantifies six domains of female sexual dysfunction (FSD), including desire, arousal, lubrication, orgasm, satisfaction, and pain. Score ≤26 indicate the presence of FSD.

Results

The mean age was 33.6 years (20 → 47 years). The mean total score of FSFI was 22.5 (3.2 → 32.6). The percentage of SD among obese women was 68.2%. FSFI score was correlated to ancient obesity (P = 0.026; r = 0.347) and waist circumference (P = 0.007; r = 0.412). High socio-economic level was correlated to desire and satisfaction (P = 0.021 and P = 0.048 respectively). Women with high educational level have better blurbification (P = 0.005). FSFI score was not correlated to BMI or obesity class.

Conclusion

Almost two-thirds of obese women have sexual dysfunctions. Women with ancient obesity and higher waist circumference seemed to have better sexual functions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Attachment representations in a population of elderly subjects

Introduction

According to attachment theory, attachment relationships have a lasting impact on the functioning of the individual. If this impact has been much studied in children, few studies have been conducted in the elderly.

Objectives

Explore the representations of attachment in a population of elderly subjects.

Methods

The sample consists of 90 consultants over the age of 65. Each participant filled out demographic questionnaire, Relationship Scale Questionnaire (RSQ): questionnaire of 13 items, each item rated from 1 to 5, a lower score attests a more secure attachment and Adult Attachment Questionnaire: a categorical scale of 3 statements. Statement 1 corresponds to secure attachment style, 2 to avoidant attachment style and 3 to anxious-ambivalent attachment style.

Results

The age of participants ranged from 65 to 95 years with an average of 68.14. The sex ratio M:F was 0.8. The RSQ Score ranged from 16 to 56 with an average of 37.27. Of the participants, 72.2% have secure attachment style, 24.4% have an avoidant attachment style and 3.3% have an anxious-ambivalent attachment style. The study of correlations showed strong correlation between the two scales (P = 0.00) and the RSQ score was significantly associated with poor satisfaction of married life (P = 0.025), presence of psychological trauma in childhood (P = 0.016) and a separation experience (P = 0.029).

Conclusion

Our study highlights the importance of early childhood experiences that may impact late adult life. These finding are in accordance with attachment theory.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Incidence of Methicillin-Resistant Staphylococcus aureus Nosocomial Infections in Intensive Care Units in Lyon University Hospitals, France, 2003-2006

We describe the trends in the incidence of methicillin-resistant Staphylococcus aureus nosocomial infection in intensive care units in Lyon hospitals from January 1, 2003, through December 31, 2006. The incidence rate decreased from 1.77 cases per 100 ICU patients in 2003 to 1.16 cases per 100 ICU patients in 2006, a reduction of 38.0% (P = .05).

[Patelar metastasis of primary lung cancer]

Patellar metastasis is uncommon. The clinical presentation is often misleading, suggestive of septic arthritis or meniscal disorder after knee trauma. We report the case of a 71-year-old patient who developed knee pain aggravated by movement with pseudo-blockage which was found to be related to a secondary localization of a primary lung cancer. Low blood flow in the patella probably explains why patellar metastasis is so rare.