Long-term Effect of Multichannel tDCS Protocol in Patients with Central Cortex Epilepsies Associated with Epilepsia Partialis Continua

Epilepsia partialis continua (EPC) is a rare type of focal motor status epilepticus that causes continuous muscle jerking in a specific part of the body. Experiencing this type of seizure, along with other seizure types, such as focal motor seizures and focal to bilateral tonic-clonic seizures, can result in a disabling situation. Non-invasive brain stimulation methods like transcranial direct current stimulation (tDCS) show promise in reducing seizure frequency (SF) when medications are ineffective. However, research on tDCS for EPC and related seizures is limited. We evaluated personalized multichannel tDCS in drug-resistant EPC of diverse etiologies for long-term clinical efficacy We report three EPC patients undergoing a long-term protocol of multichannel tDCS. The patients received several cycles (11, 9, and 3) of five consecutive days of stimulation at 2 mA for 2 × 20 min, targeting the epileptogenic zone (EZ), including the central motor cortex with cathodal electrodes. The primary measurement was SF changes. In three cases, EPC was due to Rasmussen's Encephalitis (case 1), focal cortical dysplasia (case 2), or remained unknown (case 3). tDCS cycles were administered over 6 to 22 months. The outcomes comprised a reduction of at least 75% in seizure frequency for two patients, and in one case, a complete cessation of severe motor seizures. However, tDCS had no substantial impact on the continuous myoclonus characterizing EPC. No serious side effects were reported. Long-term application of tDCS cycles is well tolerated and can lead to a considerable reduction in disabling seizures in patients with various forms of epilepsy with EPC.

Real-World Effectiveness of Dupilumab in Adult and Adolescent Patients with Atopic Dermatitis: 2-Year Interim Data from the PROSE Registry

INTRODUCTION

There is a scarcity of data beyond 1 year for the use of dupilumab to treat atopic dermatitis (AD) in a real-world setting. This study aimed to evaluate the 2-year effectiveness of dupilumab among adult and pediatric patients with moderate-to-severe AD included in a real-world, longitudinal database study.

METHODS

PROSE is an ongoing, prospective, observational, multi-center registry in the USA and Canada, designed to collect real-world data from patients aged ≥ 12 years with moderate-to-severe AD who initiate dupilumab in accordance with country-specific prescribing information. Assessments include body surface area affected by AD (BSA), Eczema Area and Severity Index (EASI), Dermatology Life Quality Index (DLQI), Pruritus Numerical Rating Scale (P-NRS), Patient-Oriented Eczema Measure (POEM), Patient Global Assessment of Disease (PGAD) questionnaire score, and occurrence of adverse events (AEs).

RESULTS

Of 764 patients who enrolled in PROSE, 632 (83%) remained in the study at the time of this interim analysis. Improvements were observed at the first post-baseline clinic visit (approximately 3 months) in the clinician-assessed measures (mean BSA and EASI scores); improvements were sustained throughout the 2-year period covered in the present study. Consistent and sustained improvements were also observed over the 2-year period in the patient-reported measures of P-NRS, POEM, and DLQI, and in the proportion of patients reporting "very good/excellent" in answer to the question in the PGAD questionnaire: "Considering all the ways in which your eczema affects you, indicate how well you are doing". Dupilumab treatment was well tolerated, with safety findings consistent with those previously reported in studies of dupilumab for the treatment of AD.

CONCLUSIONS

In the real-world PROSE registry, patients with moderate-to-severe AD experienced sustained improvement in disease control, symptoms, and quality of life up to 2 years after initiating dupilumab treatment. Safety data were consistent with the known safety profile of dupilumab.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03428646. Video abstract (MP4 20,717 kb).

Harmonization of criteria and terminology in fetal rat skeletal evaluations

BACKGROUND

A survey of laboratories in North American and Europe that routinely conduct fetal skeletal examinations was performed with the purpose of (1) understanding current terminology used for classifying skeletal findings in developmental toxicity (DT) studies and (2) understanding the criteria used to identify relatively common findings that sufficiently deviate from normal. The goal was to promote terminology harmonization and improve interlaboratory consistency in the criteria used to identify developmental anomalies.

METHODS

The survey, designed based on terminology for developmental anomalies recommended by an international collaboration (Makris et al., Congenital Anomalies, 2009;49(3):123-246), was conducted by a subgroup (authors of this publication) of the Royal Society of Biology's International Register of Fetal Morphologists (IRFM).

RESULTS

Individual and summarized anonymized responses are provided here. The authors, who are expert fetal morphologists with experience performing fetal examinations, reviewed the responses and generated recommendations on preferred terminology and criteria for determining when morphological variations deviate from normal and warrant recording of the findings for skeletal observations in Sprague Dawley (SD) fetal rats. The objective of these recommendations is to complement Makris et al. (Congenital Anomalies, 2009;49(3):123-246).

CONCLUSION

The broad application will improve interlaboratory harmonization of recording fetal skeleton findings in developmental toxicity studies intended for regulatory submissions, including SEND (Standard for Exchange of Nonclinical Data).

323 Onset of atopic comorbidities relative to atopic dermatitis diagnosis in a real-world setting using an Israeli claims database

Patients with atopic dermatitis (AD) are more likely than the general population to have other type 2 associated conditions, for example, asthma, allergic rhinitis (AR) and food allergy (FA).1,2 Classically, the atopic march is thought to begin with AD and progresses to FA, asthma and AR,1,2 but this may be an oversimplification. This study aimed to describe the epidemiology of type 2 associated conditions included in the atopic march among patients newly diagnosed with AD in a large healthcare provider database in Israel. This retrospective cohort study was performed using the Maccabi Healthcare Services database in Israel, which includes over 2.5 million members. Based on the International Classification of Diseases, 9th revision (ICD-9) diagnosis codes, patients with diagnosed AD during 2000–2019 were identified. The earliest AD diagnosis was defined as the index date and patients had to have been enrolled for ≥12 months pre-index to exclude prevalent AD. Diagnosis data were obtained during 1998–2020 to describe the cumulative prevalence of asthma, AR and FA pre- and post-AD diagnosis (−1, 0, 1, 5, 10 and 20 years) using Kaplan–Meier analysis among patients aged <3, 3–5, 6–11, 12–17 and ≥18 years at AD diagnosis. The study included 243,687 patients (51.6% female) with AD. The median (interquartile range) age at AD diagnosis was 4.3 (1.1–22.8) years, with 43.9% and 72.7% of patients diagnosed before age 3 and 18 years, respectively. At AD diagnosis, 28.1% had a prior/concurrent diagnosis of asthma/AR/FA (asthma: 17.1%, AR: 12.8%, FA: 3.4%). Among patients diagnosed with AD at age <3 years, 16.2% had been diagnosed with asthma/AR/FA by/at the time of their AD diagnosis (asthma: 10.6%, AR: 2.2%, FA: 4.9%). In this youngest age group, the cumulative prevalences of asthma/AR/FA were 28.8%, 42.7%, 49.6% and 59.6% within 1, 5, 10 and 20 years post-AD diagnosis. Among patients diagnosed with AD in adulthood, 37.7% had been diagnosed with asthma/AR/FA by/at the time they were diagnosed with AD (asthma: 16.5%, AR: 29.7%, FA: 0.8%). It this oldest age group, the cumulative prevalences of asthma/AR/FA were 40.3%, 46.1%, 50.9% and 57.6% within 1, 5, 10 and 20 years post-AD diagnosis. The results of this real-world analysis are consistent with previous evidence that AD is primarily a childhood-onset disease. The sharpest increase in type 2 associated conditions was seen in the 5 years post-AD diagnosis among patients diagnosed with AD at age <3 years. Most adults newly diagnosed with AD who developed another type 2 associated condition had already done so prior to AD diagnosis, although it is possible that earlier AD diagnoses were not captured. Regardless of age at AD diagnosis, nearly 60% of patients with AD were estimated to have ≥1 of asthma/AR/FA within 20 years of their AD diagnosis.

Use of systemic therapies in adults with atopic dermatitis: 12-month results from the European prospective observational study in patients eligible for systemic therapy for atopic dermatitis (EUROSTAD)

BACKGROUND

The European Prospective Observational Study in Patients Eligible for Systemic Therapy for Atopic Dermatitis (EUROSTAD) is an ongoing observational study aiming to describe characteristics of patients with atopic dermatitis (AD) treated with systemic therapy over time and the management of their disease in a real-world setting.

METHODS

Data from patients enrolled in EUROSTAD between March 2017 and April 2019 were analyzed for systemic therapy use and treatment change over 12 months.

RESULTS

288 patients reported taking systemic medications; 42.7% received cyclosporine, 35.3% dupilumab, 28.1% methotrexate, 25.4% oral corticosteroids, 6.8% azathioprine, 6.1% injectable corticosteroids, and 3.4% mycophenolate. The median duration of treatment was 1.1 months for oral systemic corticosteroids, 3.2 months for injectable corticosteroids, 4.8 months for cyclosporine, 7.3 months for methotrexate, and 14.9 months for dupilumab. The most frequent reasons for stopping treatment included lack of efficacy, patient decision, adverse events, and disease well controlled.

CONCLUSION

The 12-month interim EUROSTAD study analysis highlights the current trends and outcomes of systemic treatments for moderate-to-severe AD. Among all systemic treatments for AD, dupilumab was the least likely to be discontinued, whereas cyclosporine and corticosteroids, whilst effective, were primarily limited to episodic flare management consistent with treatment guidelines.

[Metacognitive deficit in schizophrenia: Characteristics and links]

OBJECTIVES

Research indicates that many patients with schizophrenia experience deficits in metacognitive capacity defined as the ability to form complex representations of themselves and others. The aim of the current study was to assess metacognitive deficit in patients with schizophrenia. These variables were collected together with many other sociodemographic, clinical and therapeutic data.

METHODS

We conducted a descriptive and analytical cross-sectional study in the psychiatry department at the Hedi Chaker University Hospital in Sfax (Tunisia). Patients were in a non-acute phase, defined by the absence of any psychiatric symptoms during the last four weeks, also, no changes in medication during the previous month had been required. An informed written consent was obtained, following which patients completed questionnaires assessing sociodemographic and clinical data during structured interviews. Symptoms and severity of the illness were assessed using the Positive and Negative Symptoms Scale (PANSS). Insight was assessed using the Insight Scale (Q8). In addition, the Metacognition Assessment Scale-Abbreviated (MAS-A) was used to assess metacognitive capacities. The MAS-A contains four dimensions: self-reflectivity, awareness of the mind of others, decentration, and mastery. Higher scores reflect an ability to effectively respond to psychological challenges on the basis of psychological knowledge.

RESULTS

We recruited 74 adults with schizophrenia disorder. The diagnosis was with DSM5. Their average age was 45 years (SD=9.84 years) with a sex ratio (M/F) of 1.552. Nineteen patients (25.5%) were married, and low educational level was present in 43% of cases. Forty patients (54%) were unemployed. Metacognitive deficit was detected in all the patients. They had low levels in all four dimensions of metacognition. The most affected dimension in our series was "Mastery". All patients had an overall insight score less than six (the average score was 2.73) with poor awareness in 62% of patients. The main factors correlated with metacognitive deficit were: occupational inactivity (P-0.015), Primary education level (P=0.045), tobacco consumption (P=0.002), low insight (P-0.001), negative symptomatology (P<10-3) and the use of first generation of antipsychotics (P=0.003). The multivariate analysis showed that three factors (occupational inactivity, low insight and the presence of negative symptomatology) were predictors of metacognitive deficits.

CONCLUSION

Based on our results, occupational inactivity, negative symptomatology and low insight are predictors of metacognitive deficit in schizophrenia. Specific therapeutics should be proposed to act on these factors. A metacognitive training program, tailored to this vulnerable population, is a priority to improve their quality of life.

Gaming addiction among Tunisian adolescent

Introduction

Gaming is a source of addiction for adolescents. It is recognized as a behavioral and mental health condition, both by the American Psychiatric Association and by the World Health Organization.

Objectives

To determine the prevalence of gaming addiction among secondary school students.

Methods

This cross-sectional study was conducted between September and October of 2020 among students enrolled in secondary school. The participants had filled the Game addiction scale and a data file regarding the socio-demographic information, physical and information about the internet access and use.

Results

The initial sample was composed of 180 secondary school students. Among them 28 were excluded because they did not play video games. Final sample consisted of 152 students (90 males, 62 females) with a mean age of 13.14 ± 1.2 years. The average duration of connection among participants was 5.3 hours per day. Nearly one quarter of the participants (24,3%) played videogames more than 20 h per week. The prevalence of gaming addiction was 21,7%. The participants with gaming addiction were, on average, younger than those who were not addicted to gaming Game-addicted individuals were more likely to be male than female (13,8% vs 7,9%; p=0,036). There was, also, a significant relation between IA and having academic difficulties (p=0.042).

Conclusions

Based on our study findings, that gaming addiction is a challenging problem among Tunisian adolescents. We recommend authorities consider gaming addiction a serious problem for the young population and make this growing phenomenon an adolescent health priority.

Disclosure

No significant relationships.

Sexual dysfunction in infertile couples

Introduction

Interactions between infertility and sexuality are numerous and complex. Recently more attention is being paid to the impact of infertility on the marital sexuality.

Objectives

The aim of this study was to determine the effects of infertility on sexual functions.

Methods

A cross-sectional descriptive study, the obstetric gynecology department Basic demographic information was collected. Respondents were surveyed regarding sexual impact and perception of their infertility etiology.

Results

Our patients had an average age of 33.2. The average number of years of infertility was 3.9 years.. The most common cause of female infertility was an ovulat disorder (36%), that of male infertility was sperm production defect. The confrontation with a diagnosis of infertility marks a difference in the way couples organize their sexual life. In our study, sexual problems after this diagnosis were experienced by 38% of women. Sexual dysfunction was detected as a pain problem (24%), a desire problem (10%), an arousal problem (4%), and an orgasm problem in 6% and. Faced with this situation, women felt guilty (46%), angry (72%) and anxious (82%). Infertility was perceived as the worst experience of life by 78% of our patients.

Conclusions

Infertility can interfere negatively in women sexuality. The investigation of sexual difficulties in infertility consultations must be systematic.

Metacognition, symptoms and general functioning in patients with schizophrenia

Introduction

Poorer metacognitive abilities are recognized as strong predictors of social functioning deficits in individuals with schizophrenia.

Objectives

The aim of the current study is to examine metacognitive functioning in people with schizophrenia and to explore correlations between metacognition, symptoms and general functioning.

Methods

It was a cross-sectional study involving outpatients diagnosed with schizophrenia and followed in the psychiatry “C” department at Hedi Chaker university Hospital, in Sfax -Tunisia, between may and december 2018. Sociodemographic, clinical and therapeutic data were measured using self-reported questionnaires, and metacognition was assessed with the Metacognition Assessment Scale – Abbreviated version (MAS-A). The general functioning was measured with The Global Assessment of Functioning (GAF).

Results

A total of 74 participants participated in the study. The average age was 34.1 ± 11.8 years and the sex-ratio was 1.6. The average score of global assessment of functioning was 49.39±10. Means and standard deviations on MAS scores were as follows: self-reflectivity 4.18 (1.46), understanding of others’ minds 3.20 (1.06), decentration 2.5 (1.8), mastery 2.54 (1.85), and the MAS total scores 12.42 (6.17). The results indicate that poor social functioning is associated with metacognitive difficulties (r=0.27, p<10-3). Greater metacognition was significantly correlated with fewer negative symptoms (r= -0.62, p<10-3), but metacognition was not significantly correlated with positive psychotic symptoms, cognitive disorganisation, excitement or emotional distress

Conclusions

These findings underscore the importance of interventions designed to enhance the patients’ metacognitive capacities, that is, the more proximal capacities linked to poorer social functioning.

Factors associated with post-traumatic stress disorder in family caregivers of psychotic patients

Introduction

An association can be found between patient with psychosis and perpetrating acts of violence. So, the caregiving role can impact negatively on psychosis carer psychological health and wellbeing.

Objectives

The aim of this study was to identify the factors associated with post-traumatic stress disorder (PTSD) in family caregivers of psychotic patients following exposure to aggression.

Methods

This cross-sectional study was carried out involving 95 family caregivers of psychotic patients followed in psychiatry. Data were gathered from caregivers about their experiences in providing care. Sociodemographic and clinical data of patients were collected from medical records.We used the perceptions of prevalence of aggression scale (POPAS) to measure the frequency and severity of aggression directed at the respondent in the past and the Impact of Event Scale-Revised (IES-R) to evaluate PTSD.

Results

The caregivers were male in 51.6% and with low educational level in 46.3% of cases. A rate of 75.8% of caregivers reported experiencing moderate to severe levels of aggression. More than a half of caregivers (54.7%) reported potentially significant levels of PTSD. Decreased contact with patient (p=0.01), male gender (p=0.00), older age (p=0.00), living far from patient (p=0.00), parent relationship of caregivers (p=0.00), diagnosis of schizophrenia or schizoaffective disorder (p=0.00) and poor adherence to treatment (p=0.00) in affected relatives were associated with the presence of PTSD following exposure to moderate to severe aggression.

Conclusions

These findings highlight the need for interventions to promote family psychoeducation and to provide psychosocial support for caregivers of patients in order to prevent the traumatic impact of violence on them.

Prevalence of internet addiction in tunisian adolescents

Introduction

Internet addiction (IA) is a significant public health issue among adolescents. There is considerable evidence that IA is associated with various psychosocial harms.

Objectives

The aim of this study was to measure the prevalence of internet addiction among secondary school.

Methods

This cross-sectional study was conducted among 152 students enrolled in secondary school. The participants had filled the Internet Addiction Test of Young and a data file regarding the socio-demographic information, physical and information about the internet access and use.

Results

The sample consisted of 90 males and 62 females with a mean age of 13.14 ± 1.2 years. The majority of participants had their own smartphone (83.6%). The average duration of connection among participants was 5.3 hours per day. The prevalence of IA was 14,5%. Results showed that 46,8% feel their internet use significantly hinders their family relationships. Twenty participants (13,2%) reported that they connected to the internet while they were in classroom. The prevalence of IA was higher among boys than girls (p= 0.018). There was, also, a significant relation between IA and having academic difficulties (p=0.037).

Conclusions

The prevalence of IA is elevated in Tunisia. Many negative consequences are identified. Urgent measures should be taken to counter the problem.

Quality of life in patients with schizophrenia

Introduction

Schizophrenia, with its high prevalence, chronic progression and social impact, is a major challenge for health professionals. For this reason it is important to assess the impact of this disease on these patients, mainly on their quality of life.

Objectives

To study the quality of life in patients with schizophrenia and determine the factors correlated with it.

Methods

A cross-sectional, descriptive and analytical study of 28 patients with schizophrenia followed up at the psychiatric consultation in Hédi Chaker University Hospital of Sfax. Data collection was performed using a sheet exploring socio-demographic and clinical data. We used the Quality of Life Scale (Q-LES-Q-SF).

Results

The average age of our patients was 40.61±6.27 years. The sex ratio (M/F) was1.15. The socioeconomic level was low in 71.4%. The average number of relapses was 3.04±1.4. Follow-up and compliance were good in 28.6% of cases. The average number of hospitalizations was 3.04±1.4. The average of quality of life in patients with schizophrenia was 21±5.74. The quality of life was affected with age (p=0.023), with the high number of relapses and with a higher number of hospitalizations in psychiatric hospital (p=0.008). Quality of life was improved with regular follow-up and good adherence to the treatment (p=0.000).

Conclusions

The quality of life in mental disorders was impaired mainly in schizophrenics, hence the need to evaluate in a codified way the quality of life of our patients in order to raise awareness among general practitioners as well as psychiatrists to improve the therapeutic and social care of patients.

Intimate partner violence and self-esteem

Introduction

The impact of intimate partner violence (IPV) can be devastating on women’s psychology. Moreover, IPV may destroy women’s self-esteem and self-identity.

Objectives

To identify sociodemographic characteristics associated with IPV and to assess self-esteem among women victims of IPV.

Methods

It was a descriptive and analytical study over a period of 03 months from June 1^st to August 31^st, 2018 including all cases IPV female victims in forensic department at Habib BOURGUIBA University Hospital, Sfax. In addition to epidemiological data, Rosenberg scale were used to assess the victim’s self-esteem.

Results

Among 142 female IPV victims, only 60 (22.3%) agreed to answer our questionnaire. Their median age was 33.5 years (27-41 years). Victims did not pass high school in 61.7% of cases and they were unemployed in 53.3% of cases. Most women got married at 23 years-old (20-26). The average length of marriage was 7 years (3-14 years). Bruises and abrasions were the most frequent lesions (58.3% and 56.7% of cases). Rosenberg Scale score’s mean was 28.3 ± 4.3. Self-esteem was low or very low among 70% of victims.

Conclusions

Female victims of IPV do not have a specific profile and low self-esteem is quite common among them. Additional research is needed to better understand the extent of the problem and to develop more effective reporting methods.

Disclosure

No significant relationships.

Insight and self-esteem in patients with bipolar disorders

Introduction

The recurrence of bipolar disorder due to poor treatment adherence can be explained by different factors.The poor awareness of the disorder seems to be the major cause.

Objectives

To evaluate insight in patients followed for euthymic bipolar disorders and determine the factors correlated with it,mainly the self-esteem.

Methods

A cross-sectional descriptive and analytical study of 33 euthymic subjects with bipolar I and II disorders (DSM 5) and followed up at the psychiatric consultation in Hédi Chaker university Hospital of Sfax.Data collection was performed using a sheet exploring socio-demographic and clinical data. We used Birchwood insight scale to assess the quality of insight and Rosenberg’s Self-Esteem scale.

Results

The average age of our patients was 44,52±12,99 years old.The sex ratio =0.32.Patients were followed for bipolar I disorder(60.6%).The first episode of the disease was depressive in(51.5%) of cases.The average number of depressive episodes was1.97±1.87.The last episode was depressive in(57.6%) or manic in(42.4%).There were no psychotic characteristics in(42.4%) of cases.The patients had good insight in(54.5%).The average of self-esteem score was27±7.85and it was low in 51.5% of cases.Factors correlated with good insight were bipolar II disorder(p=0.001), high number of depressive episodes(p=0.013) and absence of psychotic characteristics(p=0.003) during the last episode.In addition,good insight was significantly associated with low self-esteem(p=0.023).

Conclusions

Our study shows that a poor insight depends mainly on the clinical characteristics of bipolar disorders. Moreover,low self-esteem seems to be linked to it. For this reason, our attention should be focused on psychoeducation to improve insight, especially during episodes, in order to facilitate integration and increase patients’ self-esteem.

Conversion disorder in children and adolescents : Clinical features of pseudoneurological symptoms

Introduction

Pseudoneurological symptoms are frequent among children consulting in neuropediatrics. Psychogenic origin is often unrecognized, which may cause a major disruption and an increase of medical care expenses.

Objectives

The purpose of this study was to identify clinical features of pseudoneurological symptoms through patients admitted in neuropediatrics.

Methods

A descriptive retrospective study of a population of 19 children and adolescents hospitalized in the neuropediatrics department at the National Institute of Neurology in Tunis, between January 2015 and April 2019, having recieved the diagnosis of psychogenic symptoms.

Results

Twelve girls and seven boys were included in this study.The averge age were 11.5 years. All patients had normal cogntive and motor development. In most cases (84%), patients had a history of somatic illness. Only three patients had a history of psychiatric disorders. Family history of somatic disorders was found in 42 % of the sample and psychiatric disorders in three patients. Negative pseudoneurological symptoms such as loss of function, were detected in 60 % of patients, paraparesis and paraplegia were the most recurrent. Only one patient had pseudo-epileptic symptoms. Further investigations were performed in all patients, averaging 4 tests per patient. The average term between the beginning of the symptoms and the established diagnosis of psychogenic symptoms was 72 days with an average stay at hospital of 4 to 7 days. All patients had conversion disorder according to DSM V.

Conclusions

It is recognized that somatization could be a warning sign of psychological distress mainly among children. Conversion disorder, rarely seen in children, presents frequently as pseudo neurological symptoms.

Exposure to violence and risk of post-traumatic stress disorder in family caregivers of psychotic patients

Introduction

Family caregivers of psychotic patients are exposed to violence and stress. However, associated psychological outcomes are poorly characterized in this population.

Objectives

The aim of this study was to clarify the relationship between violence directed towards caregivers of patients with psychosis and developing post-traumatic stress disorder (PTSD).

Methods

Participants were family caregivers of psychotic patients (n=95). They completed a questionnaire assessing sociodemographic characteristics. Sociodemographic and clinical data of patients were collected from medical records. We used the perceptions of prevalence of aggression scale (POPAS) to measure the frequency and severity of aggression directed at the respondent in the past and the Impact of Event Scale-Revised (IES-R) to evaluate PTSD.

Results

A rate of 75.8% of caregivers reported experiencing moderate to severe levels of aggression. Decreased contact with patient (p=0.00), male gender (p=0.00), older age (p=0.00) and parent relationship (p=0.01) of caregivers, diagnosis of schizophrenia or schizoaffective disorder (p=0,00) and poor adherence to treatment (p=0,00) in affected relatives were associated with experiences of moderate–severe aggression. More than a half of caregivers (54.7%) reported potentially significant levels of PTSD which correlated with the level of aggression (p=0.00).

Conclusions

Our findings suggest that a large proportion of family caregivers of patient-initiated violence in psychosis reported experiencing a great distress and a high level of PTSD symptomatology. So, more attention should be paid to the support needs of caregivers who are faced with potentially life threatening aggressive behaviour by psychotic family members.

Association of adolescent symptoms of depression and anxiety with daily smoking and nicotine dependence in a sample of Tunisian teenagers

Aims

To examine the association of adolescent depression and anxiety symptoms with daily smoking and nicotine dependence in Tunisians teenagers.

Design

A cross-sectional study including teenagers (n = 162) from two colleges located in Gabes (south of Tunisia) and used a self-administered anonymous questionnaire. Adolescent depression and anxiety symptoms were assessed using the Hospital Anxiety and Depression scale translated and validated in Tunisia. adolescent tobacco use was defined as: daily use (6 or 7 days per week) and the loss of autonomy over tobacco use was evaluated with the Hooked on Nicotine Checklist (HONC).

Findings

The prevalence of smoking was 61.7%. It was 92% for boys and 8% for girls. In our sample, 30.7% of teenagers used manufactured cigarettes and chicha; 93.8% of daily smokers had already lost control of their smoking. Their average score the HONC was 5.5 (gap deviation 2.4). Of these, 61.3% had a score greater than or equal to 5. Rates of anxiety and depression were respectively 43% and 20%. Nicotine-dependent adolescents were significantly more anxious than non-dependent: 68.3% vs. 48.7% (P = 0.04). We do not note significant differences between depressed teenagers and adolescents without depression, regarding nicotine dependence.

Conclusions

Smoking is frequent among teenagers in Gabes. Adolescent smokers with anxiety symptoms are at increased risk for nicotine dependence. These results incite to pursue work that takes account of the specific diagnosis and treatment of tobacco dependence among adolescents, especially when psychiatric comorbidity makes smoking cessation more difficult.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

[Psoriasis in 2016 : Co-morbidities and therapeutic update]

Recognition of psoriasis as a chronic systemic inflammatory condition rather than just a skin disease is now widely accepted in the medical community. Association with joint involvement and depressive symptoms has been established for many years and several studies demonstrated an increased risk for comorbidities. These include the metabolic syndrome, obesity, hypertension, diabetes, dyslipidemia, non-alcoholic fatty liver disease, inflammatory bowel disease, and an increased incidence of cardiovascular events among those patients.

[Syphilis in pregnancy]

Inadequately treated, maternal syphilis often results in serious sequels for the fetus/newborn. Poor prenatal care is a major risk factor for the development of congenital syphilis.

AIM

To determine the results of syphilis screening and followup programs on the incidence of syphilis in pregnant women and their offspring.

MATERIAL AND METHODS

Data on the incidence of syphilis, new syphilis cases, pregnant women diagnosed with syphilis and newborns confirmed with congenital syphilis in the Iasi district in the interval 2000-2009 have been collected.

RESULTS

In the interval 2000-2010 the incidence of syphilis in the lasi district has decreased from 47.5/100,000 inhabitant in 2001 to 10.5% in 2009, and the new syphilis cases from 627 in 2001 to 87 in 2009. The highest number of pregnant women infected with syphilis was recorded in 2006 (74), and the lowest in 2010 (26). Most newborns confirmed with congenital syphilis were also recorded in 2006 (6), in the interval 2008-2010 no such case being recorded.

CONCLUSIONS

All pregnant women have to be subjected to a serological screening test for syphilis at least twice during pregnancy: early during the first trimester and after week 28. Moreover, the women at risk for syphilis have to be examined serologically at delivery. All women who miscarry after 20 weeks of gestation have to be tested for syphilis. All newborns whose mothers' serological status for syphilis was not determined during pregnancy have to be tested before discharge.

[Assessment of the congenital syphilis prevention programs]

The Romanian program for the management and screening of syphilis includes the recording, follow-up, and antenatal care of pregnant women. It aims at testing all pregnant women for syphilis with the help of VDLR (Venereal Disease Research Laboratory) or RPR (Rapid Plasma Reagin) tests, and in the women with positive tests to confirm the results by treponemal tests (treponemal antibodies): THPA (Treponema Pallidum Hemagglutination), FTA-Abs (Fluorescent Treponemal Antibody with Absorption), ELISA-Captia-IgM, and Western Blotting-IgM. In the pregnant women with positive tests two doses of 2.4 million units of penicillin G benzathine were administered at 5 days interval. These pregnant women are in the evidence of a specialist (obstetrician, dermatologist), and District Department of Public Health, and required to come for another serology test in 3 months. In case they still test positive, the same treatment is applied at the beginning of the third trimester of pregnancy.

AIM

To assess the outcome of congenital syphilis prevention programs in lasi, Romania.

MATERIAL AND METHODS

In the interval 2005-2011, in the Iasi town, 84 RPR positive pregnant women were recorded. There was no significant difference in the number of pregnant women residing in urban as compared to rural areas. Most of these women were from poor social environments and had a low level of education. The diagnosis of acquired syphilis was made by serological tests as most pregnant women presented in the period of syphilis latency, being asymptomatic. All pregnant women followed the treatment, and were tested periodically. Ultrasound examination was normal in all women (no changes suggestive of fetal malformations).

RESULTS

Free clinical, laboratory, and ultrasound investigations, history taking, psychological assessment, sex education, rapid identification of contacts of known patients, follow-up of the interaction between health care providers and syphilitic pregnant women, booklets, and leaflets altogether made that in the last 3 years (2008-2010) no new case of congenital syphilis to be reported in the study area.

CONCLUSIONS

Encouraging women to attend antenatal care early in their pregnancy is essential, this way all pregnancy-related problems (syphilis included) could be managed.

[Considerations about neoplastic intestinal occlusion]

Neoplastic intestinal occlusion represent a Frequently Surgical emergency. The present study deals with 96 cases of neoplastic intestinal occlusion from a group of 480 patients admitted and operated with diagnosis of intestinal occlusions in our clinic between 1998-2002. The patients had clinical evidence of intestinal occlusions confirmed by imaging and endoscopical examination. Median age was 50 years, females (59,40%), urban (53,12%), rectosigmoid localization (60%) advised evaluative stages was predominance. Emergency operations were performed in all cases after a short period of equilibration, 54 operations with radical intention, in 29 cases we have used a orthograde colic lavage witch help us to make a good anastomosis, 20 Hartman type, 10 colostomy, 15 exploration laparatomy. Postoperative major complications was observed in 54,48% and postoperative mortality rate was of 6,22 %.

Mycetoma: retrospective study of 13 cases in Tunisia

Mycetomas are inflammatory pseudotumors of chronic and progressive evolution, of fungal (Eumycetoma), or bacterial (Actinomycetoma) origin. We conducted a retrospective study of patients who have been consulted for mycetoma over a period of 28 years. Thirteen cases of mycetomas were collected during the 28-year period, 10 patients were of rural origin. The lesions were localized on the foot in all instances. There was no male predominance. Histopathological examination confirmed mycetoma in all 13 cases and the determination of the infectious agent in 9 cases: 4 actinomycotic and 5 fungal. Microbiological examination identified the species in 7 cases. Bone involvement was found in 10 cases. Eumycetomas were treated by ketoconazole. The other cases were treated as actinomycetomas by antibiotics. The antibiotic treatment was associated with surgical excision in 4 cases and with amputation in 1 case. Mycetomas are rare in Tunisia, and only observed sporadically, for this reason the diagnosis is usually late, with severe functional, psychological, and socioeconomic consequences.

À propos d'un cas de hernie de l'angle iléocæcal à travers l'hiatus de Winslow

A case of ileocecal herniation through the foramen of Winslow is presented. This is an uncommon type of internal hernia and the diagnosis is difficult. From this case, clinical signs, imaging procedures and treatment options are discussed.

Culture-negative endocarditis due to Chlamydia pneumoniae

We report on the case of a 54-year-old woman diagnosed as having culture-negative endocarditis (clinical and histopathologic evidence compatible with a recent episode of endocarditis). The responsibility of Chlamydia pneumoniae in this episode of endocarditis was suggested by a serological study and was then confirmed by the positive results of PCR and in situ hybridization tests with aortic and mitral valves tissues. To our knowledge, this is the first case of endocarditis due to C. pneumoniae confirmed by molecular biology-based techniques.

[Percutaneous mitral commissurotomy. 5-year results]

Long-term results of percutaneous mitral commissurotomy were evaluated in 410 patients with mean age of 31 years (18 to 68 years). 48% of patients had mean thickened leaflets, 35% had calcified valves and 17% had flexible leaflets and subvalvular apparatus. Procedure was performed with a double balloon in 57% and with Inoue's balloon in 43% patients. A good immediate results was obtained in 77% of patients. A good result was defined as a mitral valve area > or = 1.5 cm2 without mitral regurgitation. Clinical follow-up concern 378 patients. The actuarial 5 years rate were 84% in our serie, without surgery or new percutaneous mitral commissurotomy and good functional results (NYHA class I or II) were 71%. Valvular anatomy, immediate results (mitral valve area), history of mitral commissurotomy, old patients, atrial fibrillation can influence strongly the results.

Determination of the interaction force between two adsorptive surfaces delimiting a critical binary polymer blend

We consider a mixture of two incompatible polymers A and B, confined between two parallel surfaces of the same chemical nature, separated by a distance L. It is assumed that both surfaces strongly adsorb one of the species (A) at high temperature. It is also assumed that a demixing transition occurs at a critical temperature T(c) below the adsorption temperature T(a). The strong adsorption implies that the composition of species A on surfaces is quenched even when the temperature is lowered. The presence of strong density fluctuations near the critical point induces an interaction between the surfaces. We reexamine this attractive force and determine its dependence with the thickness L, when the latter is smaller than the thermal correlation length. We find that, in the vicinity of the critical point, this force decreases with distance as L-4. We show that the corresponding amplitude is a universal number, independent of the value of the composition on surfaces, and we give its exact expression. Finally, we note that the present system may be considered as a typical model enabling one to understand qualitatively and quantitatively the flocculation of colloids embedded in critical binary polymer blends.