Probiotics from kefir: Evaluating their immunostimulant and antioxidant potential in the carpet shell clam (Ruditapesdecussatus)

This study aimed to investigate the impact of incorporating kefir into the diet on biometric parameters, as well as the immune and antioxidant responses of the carpet shell clam (Ruditapes decussatus) after an experimental infection by Vibrio alginolyticus. Clams were divided into a control group and a treated group. The control group was fed on spirulina (Arthrospira platensis) alone. While, the treated group was fed on spirulina supplemented with 10% dried kefir. After 21 days, clams were immersed in a suspension of V. alginolyticus 5 × 105 CFU mL -1 for 30 min. Seven days after experimental infection, survival was 100% in both groups. The obtained results showed a slight increase in weight and condition index in clams fed with kefir-supplemented diet for 21 days compared to control clams. Regarding antioxidant responses, the treated group showed higher superoxide dismutase activity compared to the control group. However, the malondialdehyde level was lower in the treated clams than in the control. In terms of immune parameters, the treated group showed slightly elevated activities of phenoloxidase, lysozyme and alkaline phosphatase, whereas a decreased lectin activity was observed compared to the control group. The obtained results suggest that kefir enhanced both the antioxidant and immune response of infected clams.

Techno-functional characterization of gelatin extracted from the smooth-hound shark skins: Impact of pretreatments and drying methods

Gelatin derived from marine by-products could be an interesting alternative to classic mammalian gelatin. The pretreatment and extraction conditions could influence the size of the resulting peptide chains and therefore their techno-functional properties. Thus, it is important to optimize the production process to get a gelatin for the appropriate applications. Skin pretreatment was done by microwaves or oven-drying and the extracted gelatin was dried by spray- or freeze-drying. Freeze-dried gelatin extracted from untreated skin (FGUS) had the highest gelatin yield (10.40%). Gelatin proximate composition showed that proteins were the major component (87.12-89.95%), while lipids showed the lowest contents (0.65-2.26%). Glycine showed the highest level (299-316/1000 residues) in the extracted gelatins. Proline and hydroxyproline residues of gelatins from untreated skin were significantly higher than those from pretreated skin-gelatin. FTIR spectra were characterized by peaks of the amide A (3430-3284 cm-1), B (3000-2931 cm-1), I (1636-1672 cm-1), II (1539-1586 cm-1) and III (1000-1107 cm-1). Spray-drying decreased the gelling properties of gelatins, since it reduced gelling and melting temperatures compared to freeze-drying. Skin pretreatment significantly reduced the gel strength of gelatin by about 50-100 g depending on the gelatin drying method. The FGUS showed better surface properties compared to other gelatins. The highest emulsion activity index (39.42 ± 1.02 m2/g) and foaming expansion (172.33 ± 2.35%) were measured at 3% FGUS. Therefore, the promising properties of freeze-dried gelatin derived from untreated skin, gave it the opportunity to be successfully used as a techno-functional ingredient in many formulations.

LC-ESI-MS phenolic contents assessment, antioxidant, and protective ability of Punica granatum root bark extract against ethanol-induced gastric ulcer in rats: in silico H+, K+-ATPase inhibitory pathway study

The objectives of the current study were to evaluate the Punica granatum root bark extract's (PGE) antioxidant and gastroprotective activities against ethanol-induced gastric ulcers in Wistar rats and to elucidate the putative mechanism of action using in silico analysis. The PGE phytochemical study shows high levels of phenolics, flavonoids, tannins, and polysaccharides. In vitro, the PGE was more effective at scavenging hydroxyl radicals than quercetin and had lower ferric reducing activity than catechin. In vivo, it was revealed that pretreatment of ethanol-ulcerated rats with PGE at oral doses of 100, 200, and 400 mg/kg b.w. offered a dose-dependent shield against ethanol-induced ulcers when compared to Omeprazole (20 mg/kg b.w.) by preventing the development of deep ulcer lesions, lowering gastric juice output and pH rises, boosting gastric mucus production and antioxidant enzyme levels, and attenuating malondialdehyde and myeloperoxidase contents. Moreover, the liquid chromatography-mass spectrometry analysis of PGE identified 5 phenolic acids and 4 flavonoids, which revealed an in silico high oral bioavailability, drug-likenesses, and good binding affinities and thus inhibitory effects on the gastric H+, K+-ATPase enzyme. PGE may have synergistic antioxidant, anti-inflammatory, and H+, K+-proton pump inhibitory actions that contribute to its antiulcer efficacy.

Development of active edible coatings based on fish gelatin enriched with Moringa oleifera extract: Application in fish ( Mustelus mustelus ) fillet preservation

An edible coating was developed using gelatin extracted from the skin of gray triggerfish (Balistes capriscus) and applied to the fillet of the smooth‐hound shark (Mustelus mustelus). Moringa oleifera leaf extract was added to gelatin coating solution to improve its preservative properties. The phenolic profiles and antioxidant and antibacterial activities of M. oleifera extracts were determined. Phenolic acids constituted the largest group representing more than 77% of the total compounds identified in the ethanol/water (MOE/W) extract, among which the quinic acid was found to be the major one (31.48 mg/g extract). The MOE/W extract presented the highest DPPH• scavenging activity (IC₅₀ = 0.53 ± 0.02 mg/ml) and reducing (Fe³⁺) power (EC_0.5 = 0.57 ± 0.02 mg/ml), as well as interesting inhibition zones (20–35 mm) for the most tested strains. Coating by 3% of gelatin solution significantly reduced most deterioration indices during chilled storage, such as malondialdehyde (MDA), total volatile basic nitrogen (TVB‐N), weight loss, pH, and mesophilic, psychrophilic, lactic, and H₂S‐producing bacterial counts. Interestingly, coating with gelatin solution containing MOE/W extract at 20 μg/ml was more effective than gelatin applied alone. Compared with the uncoated sample, gelatin‐MOE/W coating reduced the weight loss and MDA content by 26% and 70% after 6 days of storage, respectively. Texture analysis showed that the strength of uncoated fillet increased by 46%, while the strength of fillet coated with gelatin‐MOE/W only increased by 12% after 6 days of storage. Fish fillet coated with gelatin‐MOE/W had the highest sensory scores in terms of odor, color, and overall acceptability throughout the study period.

Protective effects of dietary Kefir against aflatoxin B1-induced hepatotoxicity in Nile tilapia fish, Oreochromis niloticus

The effect of dietary Kefir supplementation on the biometric, biochemical, and histological parameters of Nile tilapia (Oreochromis niloticus) exposed to aflatoxin B1 (AFB1, 200 µg/kg diet) contamination was studied. The yeasts were dominant in Kefir followed by lactic and acetic acid bacteria. The Kefir showed relatively interesting antioxidant potential in the DPPH• (IC50 = 0.9 ± 0.02 mg/ml) and ABTS•+ (IC50 = 2.2 ± 0.03 mg/ml) scavenging activities, Fe3+-reducing power (EC0.5 = 1.2 ± 0.01 mg/ml), and β-carotene bleaching assay (IC50 = 3.3 ± 0.02 mg/ml). Three hundred and sixty Nile tilapia weighing 23 ± 5 g were divided into four groups (30 fish/group with 3 replicates), and fed with diets containing Kefir (D2), AFB1 (D3), and Kefir+AFB1 (D4) for 4 weeks, whereas D1 was kept as control group where fish were fed with basal diet. The Kefir supplementation in D4 group significantly increased (p < .05) the percent weight gain as compared to D3 group. Moreover, Kefir improved the antioxidant enzymes in the liver, such as catalase (CAT), glutathione peroxidase (GPx), and superoxide dismutase (SOD) activities, that significantly increased (p < .05) by 2-, 3-, and 1.5-folds, respectively, as compared to D3 group. The Kefir treatment significantly decreased (p < .05) the liver malonaldehyde content by ~50% as compared to D3 group. Histopathological analysis revealed the hepatoprotective effects of Kefir by showing normal liver histological architecture in D4 group, as compared to degenerative changes observed in D3 group. These results suggest that Kefir could be considered as a potential probiotic in Nile tilapia feed to mitigate the AFB1 harmful effects.

Does probiotic Kefir reduce dyslipidemia, hematological disorders and oxidative stress induced by zearalenone toxicity in wistar rats?

Zearalenone (ZEA) is a toxic metabolite of the genus Fusarium, which causes hepatotoxicity and induces oxidative stress. Kefir is an important probiotic dairy-product showing important in vitro antioxidant potential. In this study, the effect of Kefir supplementation to mitigate ZEA toxicity in rats was investigated. Animals were divided into four groups of five rats each, which received sterile milk (200 μL/day) during the first week. Then, they were switched to Kefir (200 μL/day), ZEA (40 mg/kg b. w./day) and Kefir + ZEA for the second week. Hematological and biochemical parameters, as well as liver histological analysis were determined. Kefir administration prevented the changes occurred in the count of all blood cells, and improved the antioxidant enzymes in the liver, such as catalase, glutathione peroxidase and superoxide dismutase activities that increased by 6, 4.5 and 1.3 folds, respectively, compared to ZEA group. Interestingly, the concurrent regimen Kefir + ZEA removed ZEA residues in the serum and liver. Furthermore, the Kefir + ZEA group showed a reduction in the levels of bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and hepatic malonaldehyde by ∼82, 54, 66, 50 and 36%, respectively, compared to the ZEA group. The histopathological analysis showed a normal liver histological architecture in Kefir + ZEA group, while degenerative changes were observed in ZEA group. These results suggest that Kefir as probiotic consortium may have a hepatoprotective effect against ZEA poisoning.

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Zearalenone caused oxidative stress and liver damage in rats.

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Zearalenone induced disruption of hematological and biochemical parameters.

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Kefir improved the antioxidant defense systems in rats subjected to Zearalenone.

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Kefir prevented Zearalenone-induced hepatotoxicity in rats.

Globularia alypum L. Modulates Inflammatory Markers in Human Colon and Shows a Potential Antioxidant Role in Myeloid Leukemic Cells

Globularia alypum (GA), a plant of the Globulariacea family, has long been used as a traditional cure for inflammatory and metabolic illnesses. In addition to various in vitro model studies, the current work focuses on the antioxidant and anti-inflammatory properties of GA in human colon biopsies. The phenol components in GA aqueous extract (GAAE) were identified by Liquid Chromatography-Electrospray Ionization Mass Spectrometry. The antioxidant ability of GAAE was tested in vitro utilizing chemiluminescence and flow cytometry using fluorescent yeasts n conjunction with PLB-985-human myeloid leukemia cells. Experiments on human colon biopsies after a biopsy challenge with Escherichia coli-lipopolysaccharides aimed to see if GAAE had an anti-inflammatory impact on human colon inflammation. Western blotting was used to assess the expression of several inflammatory markers. According to the findings, GAAE had a significant influence on hydrogen peroxide and cellular reactive oxygen species. GAAE inhibited the activities of cyclooxygenase 2 and nuclear factor B in inflamed biopsies, indicating anti-inflammatory action. The present study is the first to show that GA has a beneficial effect on human colon inflammation, thanks to its significant antioxidant activity in vitro. According to these preliminary data, GA may be utilized to treat a range of human inflammatory illnesses.

Development and characterization of fish gelatin-based biodegradable film enriched with Lepidium sativum extract as active packaging for cheese preservation

The physical and functional properties of gelatin-based films enriched with organic extracts from Lepidium sativum seeds were studied. Gelatin was extracted from the skin of dogfish (Squalus acanthias) and the functional gelatin-based films were used to preserve cheese during chilled storage. Ethanol extract (LSE3) and gelatin-based film enriched with LSE3 at 20 μg/mL showed high antioxidant potential using various complementary methods. No significant difference was measured in the mechanical parameters of the enriched films in terms of thickness, tensile strength and elongation at break. LSE3 incorporation at the highest level slighltly decreased the film L∗ value from 90.30 ± 0.10 to 88.10 ± 0.12, while the b∗ value increased from 0.91 ± 0.07 to 8.89 ± 0.12. Wrapping the cheese with gelatin-based film enriched with 20 μg LSE3/mL reduced the syneresis by 40% and stabilized the color, peroxidation and bacteria growth as compared to the unwrapped sample after 6 days of storage. In addition, cheese wrapped with the active gelatin-based film showed the lowest changes in texture parameters. Overall results suggest the use of the enriched gelatin film as active packaging material to preserve cheese quality.

Protective effects of Crataegus azarolus L. berries aqueous extract against castor oil-induced diarrhea, oxidative stress, and inflammation in rat

BACKGROUND

Diarrhea is a multifactorial gastrointestinal disorder responsible for about 5 million deaths annually. The chemical composition, the antioxidant activity of Crataegus azarolus berries aqueous extract (CABAE) as well as its protective effects against castor oil-induced diarrhea, oxidative stress, and inflammation in rat were studied.

METHODS

Sixty male rats were used and divided into six groups of ten animals in each: Control (C), castor oil (CO), CO+various doses of CABAE (100, 200, and 400 mg/kg b.w., p.o.), and CO+loperamide (LOP, 10 mg/kg b.w., p.o.).

KEY RESULTS

The CABAE showed relatively high levels of total polyphenols, flavonoids, and tannins. The LC-HRESIMS technique allowed the identification of 5 phenolic compounds and the major component is quinic acid. In vivo studies showed that CABAE protected against castor oil-induced diarrhea and intestinal fluid accumulation. The CABAE counteracted castor oil-induced lipoperoxidation, preserved GSH and thiol groups levels, and prevented the depletion of antioxidant enzyme activities, such as superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx). The CABAE administration also protected against castor oil-induced inflammatory markers (ALP and CRP) increase. More importantly, castor oil induced an increase of intracellular mediators, such as hydrogen peroxide, free iron, and calcium, while CABAE pretreatment significantly reversed them to near control levels.

CONCLUSION

The Crataegus azarolus berries aqueous extract significantly protected against diarrhea due in part to its antioxidant and anti-inflammatory properties.

In vitro lipolysis and physicochemical characterization of unconventional star anise oil towards the development of new lipid-based drug delivery systems

Lipid-based drug delivery systems are widely used for enhancing the bioavailability of poorly water-soluble drugs. However, following oral intake, lipid excipients often undergo gastrointestinal lipolysis, which drastically affects drugs solubility and bioavailability. That's why developing new lipid excipients which are resistant to digestion would be of great interest. We studied here the potential role of the unconventional Chinese star anise whole seedpod oil (CSAO) as an alternative multifunctional lipid excipient. Pancreatic lipase-mediated digestion of the extracted crude oil emulsion was assessed in vitro. Pancreatic lipase, being a strict sn-1,3-regioselective lipase, showed a high (16-fold) olive oil to CSAO activity ratio, which could be attributed to fatty acids composition and triglycerides intramolecular structure. For the sake of comparison, the non-regioselective lipase Novozyme® 435 exhibited higher activity than pancreatic lipase on CSAO emulsion, perhaps due to its ability to release fatty acids from the internal sn-2 position of TAGs. Apart counteracting lipolysis, CSAO oil also showed additional biopharmaceutical benefits including moderate antioxidant and antihypertensive activities. Altogether, these findings highlight for the first time the potential use of star anise unconventional whole seedpod oil as a multifunctional lipid excipient for the development of new lipid formulations.

Antidiarrheal, Antimicrobial, and Antioxidant Properties of the Aqueous Extract of Tunisian Persimmon (Diospyros kaki Thunb.) Fruits

Medicinal plants were used to prevent and treat numerous gastrointestinal disorders owing, in part, to their antioxidant capacity. The protective effects of Diospyros kaki fruit aqueous extract (DKFAE) against castor oil (CO)-induced diarrhea was studied. The in vitro antioxidant and antibacterial properties were investigated using colorimetric and biochemical analyses. In vivo, 60 male rats were divided into 6 groups of 10 animals each (n = 10): control (C), CO, CO+various doses of DKFAE (100, 200, and 400 mg/kg, b.w., p.o.), and CO+loperamide (LOP, 10 mg/kg, b.w., p.o.).The DKFAE was rich in tannins and showed interesting antioxidant and antibacterial activities. The liquid chromatography-electrospray ionization mass spectrometry (LC-ESI-MS) analysis resulted in the identification of 16 phenolic compounds, among which quinic acid was the main one. The in vivo study showed that diarrhea was accompanied by an oxidative stress status as measured by an increase of lipid peroxidation, a decrease of glutathione and thiol group levels, as well as antioxidant enzyme activity depletion, such as glutathione peroxidase, superoxide dismutase, and catalase. The DKFAE administration significantly decreased the gastrointestinal transit in a dose-dependent manner. Besides, DKFAE protected against CO-induced diarrhea and intestinal fluid accumulation. Interestingly, DKFAE pretreatment counteracted all the oxidative stress status deregulation induced by CO intoxication. D. kaki fruit could be suggested for its strong protective effect against CO-induced acute diarrhea, which could be explained, in part, to its antimicrobial and antioxidant properties.

Title: Risk factors of prolonged corrected QT interval among patients with mental disorders

Introduction

There is an increased rate of sudden cardiac death in mental health patients. Studies provide consistent evidence that prolonged QT interval is associated with higher risk of all-cause and cardiovascular mortality.

Objectives

This study aimed to assess the prevalence of prolonged QTc interval (corrected QT>450 milliseconds) and to determine the possible factors in hospitalized psychiatric patients.

Methods

We reviewed records of all mental health inpatient admissions to the psychiatry “C” department at Hedi Chaker university hospital in Sfax, between 1 february and 30 april 2019. Electrocardiogram (ECG) availability was noted and QTc interval was manually measured. Sociodemographic, clinical, biological and therapeutic data were collected.

Results

Of 68 mental health inpatient admissions, 59 (86.6 %) presentations had an ECG. A total of seven (11.8 %) had a prolonged QTc interval. These seven patients were treated with typical antipsychotics. Of the 7 patients with a prolonged QTc, 4 patients (57.1%) suffered from schizophrenia. QTc prolongation was significantly correlated with the presence of a recent physical trauma (p = 0.021), dietary restriction (p = 0.026), and taking at least two antipsychotics (p = 0.008). Moreover, this prolongation of QTc was linked to a longer duration of disease and an older age, without significant associations.

Conclusions

Our study supports an association between a prolonged QTc interval and clinical situations at risk and antipsychotic polypharmacy. However, a larger study with routine ECG screening is required to better assess the significance of this problem.

Pistacia atlantica Desf. roots extract: LC-ESI-MS Analysis, antioxidant activity and gastroprotective effect on experimentally-induced ultrastructural gastric ulcers in mice

Pistacia atlantica Desf. (Atlas Pistachio) is an Anacardiaceae tree traditionally used in Tunisia for the treatment of ophthalmic, stomatitis, and digestive tract diseases. In the present study, the Pistacia atlantica Desf. roots extract (PR) was phytochemically analyzed, for the first time, by LC-ESI-MS for phenolic and flavonoid contents, in vitro tested for its potential antioxidant activity based on the 2.2-diphenyl-1-picrylhydrazyl (DPPH) and the reduced power essays (FRAP), and in vivo tested for its ability to shield against ethanol-induced gastric ulcer in mice. The LC-ESI-MS analysis proved the identification of 12 compounds, including Quinic, Gallic, and Protocatechuic, as major phenolic acids and high levels of flavonoids, such as Catechin, Epicatechin, and Cirsiliol. PR also exhibited a mild in vitro antioxidant activity when compared with ascorbic acid. In vivo pretreatment of ethanol-ulcerated mice with PR doses 50 mg/kg and 100 mg/kg body weight (b.w) significantly reduced (P< .05) gastric lesions at a rate of 20.10% and a rate of 40.90%, respectively, when compared with 60.70% rate of sucralfate (50 mg/kg b.w) evidenced by a dose-dependent manner increase in the gastric mucosa enzymatic (SOD, CAT, GPx) antioxidant levels, the decline of the lipid peroxidation, and the preservation of normal gastric superficial epithelium. The underlying mechanism of PR antiulcerogenic activity could be due to a synergistic effect of phenolic acids and flavonoid contents which enhances the gastric antioxidant defense system.Abbreviations: BHT: butylated hydroxytoluene, b.w: body weight, CAT: catalase, DPPH:1-Diphenyl-2-picrylhydrazyl, DW: dry weight, EtOH: ethanol, FRAP: Ferric reducing antioxidant power, GAE: gallic acid equivalents, GPx: Glutathione peroxidase, QE: quercetin equivalents, LC-ESI-MS: Liquid chromatography-Electrospray Ionization-Tandem Mass Spectrometry, MDA: malondialdehyde, PR: Pistacia root, TBA: thiobarbituric acid reagent, TBARS: thiobarbituric acid reactive substances, TCA: trichloroacetic acid, SOD: Superoxide dismutase.

Brown seaweed Cystoseira schiffneri as a promising source of sulfated fucans: Seasonal variability of structural, chemical, and antioxidant properties

A fucoidan, sulfated polysaccharide, was extracted from the brown seaweed Cystoseira schiffneri during 4 harvest periods (December, April, July, and September) and studied for its structural and chemical properties. The Cystoseira schiffneri fucoidan (CSF) showed important variation in sulfate content ranging from 7.8% in December to 34.8% in July. This was confirmed by Fourier transform infrared and nuclear magnetic resonance spectroscopies showing characteristic signals of sulfated polysaccharides. Molecular mass of the CSF varied as a function of season from 3,745 in December to 26,390 Da in July. Gas chromatography-mass spectroscopy showed that CSF fractions were "mannogalactofucans" composed mainly of mannose, fucose, and galactose with low levels of other monosaccharides. Moreover, interesting in vitro antioxidant activities that depend on the harvest season were noted for CSF. Thus, the present work might contribute to establish criteria for extracting bioactive fucoidans from an endemic Tunisian seaweed C. schiffneri.

Chemical Characterization of Bioactive Components of Rosa canina Extract and Its Protective Effect on Dextran Sulfate Sodium-Induced Intestinal Bowel Disease in a Mouse Model

Rosa canina is a well-known medicinal plant used in folk remedy that alleviates various disorders, including inflammation, gastritis, and diarrhea. The objective of this investigation was to identify and quantify the phenolic components of R. canina methanolic extract (RCME) and to determine its protective action with dextran sulfate sodium (DSS)-generated mice colitis model. RCME chemical analysis was done using Liquid Chromatography-Electrospray Ionization-Tandem Mass Spectrometry, and experimental animals received RCME at different doses before colitis induction by oral DSS administration during 7 days. Another group received sulfasalazine as a positive control. Colitis damages and RCME benefits were assessed using histopathological and biochemical changes and improvements. Many phenolic compounds have been identified. In addition, the DSS intoxication induced an alteration of colonic epithelium associated with an oxidative stress state. DSS administration led to an increase or decrease of intracellular mediators such as free iron and ionizable calcium. RCME consumption effectively protected against colonic histological/biochemical alterations induced by DSS intoxication providing support for the traditional use of this plant.

[Factors associated with Internet addiction among Tunisian adolescents]

INTRODUCTION

Internet addiction, a relatively new phenomenon, is a field of recent research in mental health, particularly within young populations. It seems to interact with several individual and environmental factors.

OBJECTIVES

We aim to spot internet addiction in a Tunisian adolescent population, and to study its relationship with personal and family factors, as well as with anxious and depressive comorbidities.

METHODS

We conducted a cross-sectional study of 253 adolescents recruited in public places in the city of Sfax in the south of Tunisia. We collected biographical and personal data as well as data describing family dynamics. The internet addiction was assessed by Young's questionnaire. Depressive and anxious co-morbidities were assessed using the HADS scale. The comparative study was based on the chi-square test and the Student's test, with a significance level of 5 %.

RESULTS

The prevalence of internet addiction was 43.9 %. The average age of internet-addicts was 16.34 years, the male sex was the most represented (54.1 %) and increased the risk of internet addiction (OR a=2.805). The average duration of connection among Internet addicts was 4.6hours per day and was significantly related to internet addiction; P<0.001). Socializing activities were found in the majority of the internet-addicted adolescents (86.5 %). The type of online activity was significantly associated with internet addiction (P=0.03 and OR a=3.256). Other behavioral addictions were frequently reported: 35.13% for excessive use of video games and 43.25 % for pathological purchases. These two behaviors were significantly associated with internet addiction (with respectively P=0.001 and P=0.002 with OR=3.283). The internet-addicted adolescents lived with both parents in 91.9 % of cases. The mother's regular professional activity was significantly associated with internet addiction risk (P=0.04) as was the use of the Internet by parents and siblings (with respectively P=0.002 and P<0.001 with OR=3.256). The restrictive attitude of the parents was significantly associated with internet addiction risk (P<0.001 OR=2.57). Family dynamics, particularly at the level of adolescent-parent interactions, were a determining factor in internet addiction. Anxiety was more frequently found than depression among our cyber-dependent adolescents with frequencies of 65.8 % and 18.9 %, respectively. Anxiety was significantly correlated with the risk of internet addiction (P=0.003, OR a=2.15). There was no significant correlation between depression and the risk of internet addiction.

CONCLUSION

The Tunisian adolescent seems at great risk of internet addiction. Targeted action on modifiable factors, especially those affecting family interactions, would be very useful in prevention.

Nephroprotective and antioxidant effect of green tea (Camellia sinensis) against nicotine-induced nephrotoxicity in rats and characterization of its bioactive compounds by HPLC-DAD

Nicotine is a potential inducer of oxidative stress, through which it can damage numerous biological molecules. Natural antioxidants that prevent or slow the progression and severity of nicotine toxicity may have a significant health impact. The purpose of this study, conducted on Wistar rats, was to evaluate the beneficial effects of green tea (Camellia sinensis) extract on nicotine treatment-induced damage on kidney. Our results showed that nicotine significantly (p < 0.01) increased serum and kidney malondialdehyde, the serum contents of urea, creatinine, and uric acid. In addition, nicotine intoxication significantly (p < 0.01) decreased the levels of vitamins E and C in serum and kidney tissue as well as the activities of superoxide dismutase, catalase, and glutathione peroxidase. Interestingly, animals that were pretreated with green tea, prior to nicotine administration, showed a significant nephroprotection, revealed by a significant reduction-induced oxidative damage for all tested markers. The nephroprotective activity of green tea is mediated, at least in part, by the antioxidant effect of its constituents.

Life-threatening subglottic hemangioma in an infant successfully treated with propranolol

Subglottic hemangioma is a rare benign tumor in children. It causes an obstruction of the upper airway and can be life-threatening. Several therapeutic options have been used in the literature, including surgery. Currently, the treatment is essentially based on propranolol. We report the case of a 2-month-old female infant hospitalized for severe obstructive dyspnea secondary to a subglottic hemangioma. Diagnosis was confirmed by laryngoscopy and magnetic resonance imaging. The child underwent a tracheotomy and was treated with propranolol. The progression was favorable with regression of the subglottic hemangioma and improvement of laryngotracheal airway obstruction.

Protective effects ofMentha spicataagainst nicotine-induced toxicity in liver and erythrocytes of Wistar rats

The aim of this study was to investigate the protective effect of Mentha spicata supplementation against nicotine-induced oxidative damage in the liver and erythrocytes of Wistar rats. Bioactive substances were determined by liquid chromatography – electrospray ionization – tandem mass spectrometry analysis. Animals were divided into 4 groups of 6 rats each: a normal control group, a nicotine-treated group (1 mg/kg), a group receiving M. spicata extract (100 mg/kg), and a group receiving both M. spicata extract (100 mg/kg) and nicotine (1 mg/kg). Many phenolic acids were identified in the M. spicata aqueous extract. After 2 months of treatment, nicotine induced an increase in the level of white blood cells and a marked decrease in erythrocytes, hemoglobin, and haematocrit. Aspartate transaminase, alanine transaminase, alkaline phosphatase, and lactate dehydrogenase activities were also found to be higher in nicotine-treated group than those of the control group. Furthermore, nicotine-treated rats exhibited oxidative stress, as evidenced by a decrease in antioxidant enzymes activities and an increase in lipid peroxidation level in liver and erythrocytes. Interestingly, the oral administration of M. spicata extract by nicotine-treated rats alleviated such disturbances. M. spicata contained bioactive compounds that possess important antioxidant potential and protected liver and erythrocytes against nicotine-induced damage.

Phytochemical, antioxidant and protective effect of cactus cladodes extract against lithium-induced liver injury in rats

CONTEXT

Opuntia ficus-indica (L.) Mill. (Castaceae) (cactus) is used in Tunisian medicine for the treatment of various diseases.

OBJECTIVE

This study determines phytochemical composition of cactus cladode extract (CCE). It also investigates antioxidant activity and hepatoprotective potential of CCE against lithium carbonate (Li₂CO₃)-induced liver injury in rats.

MATERIALS AND METHODS

Twenty-four Wistar male rats were divided into four groups of six each: a control group given distilled water (0.5 mL/100 g b.w.; i.p.), a group injected with Li₂CO₃ (25 mg/kg b.w.; i.p.; corresponding to 30% of the LD₅₀) twice daily for 30 days, a group receiving only CCE at 100 mg/kg of b.w. for 60 days and then injected with distilled water during the last 30 days of CCE treatment, and a group receiving CCE and then injected with Li₂CO₃ during the last 30 days of CCE treatment. The bioactive components containing the CCE were identified using chemical assays.

RESULTS

Treatment with Li₂CO₃ caused a significant change of some haematological parameters including red blood cells (RBC), white blood cells (WBC), haemoglobin content (Hb), haematocrit (Ht) and mean corpuscular volume (VCM) compared to the control group. Moreover, significant increases in the levels of glucose, cholesterol, triglycerides and of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) activities were observed in the blood of Li₂CO₃-treated rats. Furthermore, exposure to Li₂CO₃ significantly increased the LPO level and decreased superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) activities in the hepatic tissues.

CONCLUSION

CCE possesses a significant hepatoprotective effect.

Impact of coping strategies on emotional status in patients with obstructive sleep apnea syndrome

Introduction

Obstructive sleep apnea syndrome (OSAS) is a common sleep disorder, which leads to higher morbidity, and mortality and can result in various psychological problems, such as depression.

Objectives

The purpose of this study was to assess the severity of depression and to examine its relationships with coping strategies in OSAS patients.

Methods

We performed an analytical cross-sectional study of 87 recently diagnosed OSAS patients. Apnea hypopnea index (AHI) was determined by an overnight polysomnography. Depressive symptoms were evaluated by the hospital anxiety and depression scale (HADS). Coping strategies were assessed by the brief cope.

Results

Subjects included 38 men and 49 women averaging 55.7 years of age (SD = 11.6) with a mean body mass index (BMI) of 33.8 kg m−2. According to the AHI, 70.1% of the patients had severe OSAS, and 16.1% had moderate OSAS. Depressive symptoms were found in 44.8% of all patients. Emotional coping was used by 72.4%, while problem-focused coping was used by 28.7% of the patients. The score of depression on HADS (HADS-D) showed positive correlation with BMI (r = 0,48; P ≤ 0.001). No significant association was found between HADS-D and AHI. Depressive symptoms were associated with more emotional coping (P = 0.03) and with less problem-focused coping (P = 0.002).

Conclusion

Our findings suggest that depression is highly prevalent among patients with OSAS, and that coping style seems to have a significant influence on emotional status in these patients. Further research should explore the possibilities of intervening on this factor, aiming to lessen depressive symptoms in OSAS patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Perceived Competence in Adolescents Having Prosocial Behaviour: A Tunisian Study

Introduction

Perceived competence (PC) is a self-perception of an individual in its capabilities and ability to control his environment. It is posited to orient individuals to the possibility of success and to facilitate the adoption of approach goals.

Objectives

We aimed to assess the PC of adolescents engaged in prosocial activities and to determine factors that influence it.

Methods

We led a transversal study, over four months, from June until September 2016. It included 90 adolescents aged 14–20 years and members of voluntary association in Sfax (Tunisia). PC was assessed using the “perceived competence in life domains” (PCLD) for the life spheres of leisure, interpersonal relationships, school, and general domains.

Results

The average age of participants was 16 (14 to 20 years). The sample was female-dominated (53%). All participants were secondary school pupils. Almost 70% were from a high socio-economic level and over 60% had parents’ high level of education.

The mean scores of PC ranged from 19 (SD = 5.4) in leisure domain to 16 (SD = 4) in interpersonal relationships domain. PC was significantly correlated with socio-economic level (P = 0.00), participating in sports and extra- curricular activities (P = 0.00), academic proficiency (P = 0.01) and smoking (P = 0.00).

Conclusion

Overall, our results evidenced the positive self-perception of competence among adolescents having prosocial activities. It indicated that high socio-economic level, participating in sports and extra-curricular activities and smoking were enhancing factors of adolescents PC.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Early and Late Onset Bipolar Disorders in Older Adults

Introduction

Age of onset of illness may be useful in explaining the heterogeneity among older bipolar patients.

Objective

To examine the relationship of age of onset with clinical, demographic and behavioral variables, in older patients with bipolar disorder.

Methods

This was a cross-sectional, descriptive and analytical study, including 24 patients suffering from bipolar disorders, aged 65 years or more and followed-up in outpatient psychiatry unit at Hedi Chaker university hospital in Sfax in Tunisia. We used a standardized questionnaire including socio-demographic, behavioral and clinical data. Age of onset was split at age 40 years into early-onset (< 40 years; n = 12) and late-onset (≥ 40 years; n = 12) groups.

Results

The mean age for the entire sample was 68.95 years. The mean age of onset was 39.95 years. The majority (60%) of patients were diagnosed with bipolar I. Few meaningful differences emerged between early-onset and late-onset groups, except that tobacco use was significantly higher in the late-onset group (66.6% vs. 16.6%; P = 0.027). No significant differences between the early-onset and late-onset groups were seen on demographic variables, family history and number of medical diagnoses or presence of psychotic features.

Conclusion

Our study found few meaningful behavioral differences between early versus late age at onset in older adults with bipolar disorder.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The synergistic relationship between perceived autonomy and environmental factors in adolescents with prosocial behaviour

Introduction

Perceived autonomy (PA) can be considered as the key mediating variable in promoting intrinsic motivation. Therefore, an environment that encourages autonomy increases intrinsic motivation and leads to continuance intention.

Objectives

The main purpose of this study was to assess the social conditions which give rise to autonomous forms of motivation.

Methods

We led a transversal study, over four months, from June until September 2016. It included 90 adolescents aged 14–20 years and members of voluntary association in Sfax (Tunisia). PA was assessed using the “perceived autonomy in life domains” (PALD) for the life spheres of leisure, interpersonal relationships, school, and general domains.

Results

The average age of participants was 16 (14 to 20 years). The sample was female-dominated (53%). All participants were secondary school pupils. Almost 70% were from a high socioeconomic level and over 60% had parents’ high level of education.

The mean scores of PA ranged from 117 (SD = 4.5) in general domain to 15 (SD = 4.5) in school domain.

There was a significant correlation between PA and parents’ level of education (P = 0.01), parental relationship (P = 0.01), level of family communication (P = 0.00), giving compliments (P = 0.01) and rights in decision-making (P = 0.05). The other factors that significantly enhance PA were having a good network of friends (P = 0.01) and having sports and extracurricular activities (P = 0.03).

Conclusion

The present findings provide additional support for the synergistic relationship between family dynamics and family relationship perceptions and PA, and emphasize the role of parents to encourage autonomy.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Risk factors of self-injury behavior among psychiatric inpatients

Background

Self-injury behavior among mental patients has been recognized for several years, yet our understanding of its mechanisms and its risk factors remains limited.

Objectives

This study aimed to assess the prevalence of deliberate self-harm (DSH) among psychiatric inpatients and to identify its association with personal and clinical factors.

Methods

It was a descriptive and analytic study. It included 87 psychiatric inpatients followed in the psychiatry department “C” at the Hedi Chaker University Hospital of Sfax in Tunisia. Barratt Impulsivity Scale (Bis11) and the 28-items Childhood Trauma Questionnaire (CTQ) were used to assess respectively impulsivity and child maltreatment.

Results

The average age of patients was 29.32 ± 8 years. Most of them were male (75%) and single. Fifty-nine percent of patients had previously attempted suicide. A history of DSH was found in 60.9% of cases. The most frequent trauma types were emotional abuse and physical neglect with respectively 58.7% and 69.8%. Factors positively correlated with DSH were: male gender (P = 0.026), father alcoholism (P = 0.024), history of suicide attempts (P = 0.017), borderline personality (P = 0.00) and history of emotional abuse (P = 0.008) or physical abuse (P = 0.04) or neglect (P = 0.004). Score “Bis11” was significantly correlated with suicide attempts (P = 0.00) and presence of childhood abuse (P = 0.00) or neglect (P = 0.01).

Conclusion

DSH seems to be a prevalent problem among psychiatric inpatients. It concerns mainly patients with a history of child abuse and impulsive behavior such as suicidal attempts underlying borderline personality disorder. Patients with these risk factors warrant specific attention in mental health services.

Disclosure of Interest

The authors have not supplied their declaration of competing interest.

Forensic psychiatric expertise of patients with anti-social personality

Introduction

Epidemiological studies in the general population confirm the indisputable link between criminological dangerousness and mental disorders especially anti-social personality, which increase clearly the prevalence of violent behavior.

Aim

To dress socio-demographic, clinical and medico-legal profile of offenders, with anti-social personality, in forensic psychiatric examination.

Methods

It was a retrospective study of a series of 195 patients with antisocial personality (DSM-IV). They were examined, during the period, from 2009 to 2013, on the occasion of a penal expertise in the department of psychiatry C in the Hedi Chaker university hospital, Sfax, Tunisia.

Results

The mean age of patients at the offense moment, was 29.58 years, with a sex ratio of 26.85. Among them, 66.2% were single, 49.2% had a primary school level and 41% had no profession. Between the patients, 58.5% lived in urban area and 38.5% in a high crime area. Addictive behaviors were reported in 80% of cases. Self-injury behaviors were noted in 33.8% of offenders. Psychiatric histories were reported in 66.2%, and 25.6% of patients have been already hospitalized in psychiatry department. 64.1% had already committed forensic acts, and 36% had been imprisoned at least once. The current offense was: homicide 16.9%; sexual offense 9.2%; violence 18.5%; theft 30.2%. The offense was related to impulsivity (40%) or utilitarian purpose (39%).

Conclusion

A young single man with no profession, a limited educational attainment and a history of impulsive behaviors, such is the profile most frequently encountered among offenders with anti-social personality. Interventions for reducing forensic behavior should focus on those social and clinical characteristics.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Impulsivity and Current Alcohol Use in Adolescents

Introduction

Many studies have focused on the strong link between impulsivity and addictive behaviors, such as alcohol use disorders.

Objective

Our study aimed to investigate the links between alcohol use and impulsivity in a sample of Tunisian pupils.

Methods

This was a cross-sectional study conducted in May and June 2016. It enrolled 317 pupils from four colleges and schools in Sfax (Tunisia). The participants were asked to answer a self-administered questionnaire, after their consent. Alcohol use disorders identification test (AUDIT) was used to evaluate alcohol dependence. The Barratt Impulsiveness Scale (BIS), in its 11th version, was used to assess impulsivity trait. Its three second-order factors were attentional impulsiveness, motor impulsiveness, and non-planning impulsiveness.

Results

The mean age was 16 years with a sex-ratio of 1.07. The school children reported having drunk alcohol at least once in 18.9% of cases and 41.66% of them still consume. According to AUDIT, 1.6% of alcohol users presented an alcohol misuse and 21.6% presented dependence. According to BIS, impulsivity prevalence (IP) in the whole sample was 27.8% while it was 40% among the alcoholic participants versus 24.9% in non-alcoholic participants. The average BIS score was more important in the alcoholic participants (69.25 versus 65.53; P = 0.011). Alcohol consumption was correlated to attentional impulsiveness (P = 0.01) and motor impulsiveness (P = 0.008). Alcohol dependence was correlated to motor impulsiveness (P = 0.018).

Conclusion

These results show the importance of clinically evaluating and intervening on impulsive personality traits to better prevent addictive behavior such as alcoholism among adolescents.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Clinical differences between unipolar and bipolar depression

Introduction

Epidemiological studies indicate that the majority of patients with bipolar disorder are diagnosed many years later. Unipolar depression represents the most frequent misdiagnosis.

Objectives

This study aimed to examine the symptom profiles of depressed patients in order to identify clinical specificities of bipolar depression.

Methods

A total of 31 depressed patients were recruited from psychiatry outpatient department of Hedi Chaker university hospital in Sfax (Tunisia), during October and November 2016. Unipolar and bipolar patients were compared on a broad range of parameters, including sociodemographic and clinical characteristics. Depressive symptoms were rated using the Montgomery Asberg Depression Rating Scale (MADRS) and Bipolar Depression Rating Scale (BDRS).

Results

The total sample comprised 31 patients with 16 men and 15 women. It involved 20 with unipolar depression and 11 with bipolar depression. Patients with bipolar depression had more family history of bipolar disorder (P = 0.037) and a triggering factor had been identified less often (P = 0.03). MADRS scores were similar in bipolar and unipolar patient (median score 28.22 versus 28.36; P = 0.964). BDRS scores were significantly higher in bipolar depressed patients (median score 33 versus 25; P = 0.01). The mixed subscale (item 16 to 20) scores were particularly higher (median 6 vs. 1.2; P ≤ 0.01) especially concerning irritability (P = 0.001). Increased motor drive (P = 0.004) and agitation (P = 0.008).

Conclusion

Our findings suggest that the presence of mixed symptoms is very important to recognize depressed patients as having a bipolar disorder. We also recommend routine use of the BDRS for patients presenting for treatment of depression.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Psychological distress and alcohol use among adolescents

Introduction

Anxiety and depression, as well as alcohol use are widespread among teenagers, and constitute a huge public health burden worldwide.

Objective

To study the link between alcohol consumption and emotional distress (anxiety and depression) among adolescents.

Methods

We conducted a cross-sectional study in May and June 2016. The sample consisted of 314 pupils from 4 colleges and schools in Sfax (Tunisia). Alcohol Use Disorders Test (AUDIT) was used to evaluate alcohol dependence. Anxiety and depression levels were evaluated using the “Hospital Anxiety and Depression Scale” (HADS).

Results

The mean age was 16 years with a sex ratio of 1.08. Among the participants, 18.9% reported having drunk alcohol at least once and 42.37% of them still consume. The main reasons for alcohol initiation were the search of new experiences (78%) or pleasure and well-being (39%) and the curiosity (49.15%). According to AUDIT, 1.7% of alcohol users presented an alcohol misuse and 20% presented dependence.

The prevalence of anxiety and depression were respectively 56.1% and 23.7%. Anxiety was correlated to alcohol experimentation (P = 0.03) and non-supportive environment (P = 0.003). Depression was correlated to alcohol experimentation (P = 0.001), AUDIT score (P = 0.009), somatic histories (P = 0.02), physical abuse (P = 0.02), non-supportive environment (P = 0.016) and graduating class level (P = 0.005).

Conclusion

Our study highlights the close association between alcohol consumption and emotional distress in adolescence, which seems to be bi-directional. When attempting to reduce the risk of alcohol consumption, we should focus a particular attention on adolescents studying in graduating class, reinforce adolescents’ family support and prevent physical abuse.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Quality of life and its relationship with illness representations in patients with obstructive sleep apnea syndrome

Introduction

Obstructive sleep apnea syndrome (OSAS) is a highly widespread sleep-related breathing disorder that leads to serious impairment in quality of life (QOL).

Objectives

We aimed to assess QOL in patients with OSAS and to investigate its relationship with illness representations.

Methods

We performed an analytical cross-sectional study of 87 recently diagnosed OSAS patients. Apnea hypopnea index (AHI) was determined by an overnight polysomnography. Excessive daytime sleepiness (EDS) was assessed by the Epworth Sleepiness Scale (ESS). QOL was assessed by the 36-item short form health survey (SF-36). Illness representations were measured by the Brief Illness Perceptions Questionnaire (B-IPQ); High scores reveal a more threatening perception of the illness.

Results

Mean age of the participants was 55.7 years (SD = 11.6). According to the AHI, 70,1% of the patients had severe OSAS, and 16.1% had moderate OSAS. The mean score of the SF-36 was 40.2 (SD = 18.7). Overall QOL was impaired in 87.7% of the patients. There was a considerable decrease in both mental and physical QOL. EDS was associated with impairment in mental QOL. Illness representations were negatively correlated with overall QOL (r = - 0.45; P < 0.01). No relationship was found between QOL and illness severity.

Conclusion

The present study provides evidence that OSAS has serious influence on QOL of patients, which could be mediated by negative illness perception. So it is extremely important to know how OSAS sufferers perceive their illness to better understand their coping behavior and to improve their adherence to treatment and their QOL.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Psychiatric morbidity managed by liaison psychiatry in a Tunisian population

Introduction

The epidemiology of the association between mental disorders and medical illnesses is the subject of many research studies, mainly due to the worse prognosis associated with this comorbidity.

Objectives

To investigate the psychiatric morbidity associated with somatic diseases in liaison psychiatry outpatients and to identify factors associated with this morbidity.

Methods

A descriptive and analytical cross-sectional study was conducted. It took place at the psychiatry outpatient unit at CHU Hedi Chaker of Sfax in Tunisia. We collected 110 files of patients having a medical and/or surgical condition, addressed for the first time in 2014, as part of liaison psychiatry.

Results

Major depressive disorder (MDD) and adjustment disorder (AD) with anxious and/or depressive mood were the most common diagnoses in liaison psychiatry (respectively 53 cases and 28 cases).

MDD has been diagnosed mainly during the course of three somatic illnesses: cancer, sciatica and hypertension, with respective rates of 90%, 85.7% and 60%.

The onset of a MDD during the evolution of a somatic disease was significantly more common in female patients (P = 0.04) and those living in couple family (P = 0.005).

Conclusion

Among all psychiatric disorders, depression and AD were the most frequently associated disorders with somatic diseases. This comorbidity may be explained by the physiological and psychological impact of certain somatic diseases, the iatrogenic effect of certain treatments, or the involvement of a biological, psychological or environmental common factor for both conditions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Prevalence of psychiatric comorbidities in epilepsy

Introduction

Epilepsy is a chronic disease defined as a brain disorder, characterized by a predisposition to present seizures, generating cognitive, psychological, and social consequences.

Objective

To determine the prevalence of psychiatric comorbid disorders in patients with epilepsy (PWEs) and its associated factors.

Methods

We conducted a cross-sectional study involving 30 PWEs who were treated in the neurology department of Habib Bourguiba Hospital in Sfax, Tunisia. We used the Mini International Neuropsychiatric Interview for the diagnosis of Axis I psychiatric disorders.

Results

The half of patients had psychiatric comorbidities: 4 had major depressive disorder (MDD), 2 had MDD with generalized anxiety disorder, 4 had MDD with social phobia, 1 had bipolar disorder type I, 1 had panic disorder, 1 had agoraphobia and 2 had generalized anxiety disorder.

Twenty-five PWEs had seizure-onset below 30 years old and among them, 40% had psychiatric comorbidities. Among patients who had seizure-onset above 30 years old, none had psychiatric comorbidities. Psychiatric comorbidities were found in 71.5% of patients with seizure frequency >2 per year. Psychiatric comorbidities were more common in patients with generalized seizures compared to whom with partial seizures (53% versus 45%). It was also more common in patients treated with polytherapy compared to whom with monotherapy (64% versus 37.5%).

Conclusion

The prevalence of psychiatric comorbidities is relatively high among PWEs. The most frequent diagnoses found were mood and anxiety disorders. It is very important to identify them and treat them to enhance seizure control.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Generalized anxiety disorder comorbidities: Panic and depressive disorder

Introduction

It has been well documented that generalized anxiety disorder (GAD) can co-occur with mood disorders and other anxious disorders, particularly panic disorder (PD). These comorbidities can complicate therapeutic management and burden the prognosis.

Aim

To highlight the relationship between GAD and panic and depressive disorders.

Methods

We conducted a cross-sectional study, among 250 subjects consulting in 6 primary care units in Sfax, Tunisia. These participants, randomly chosen, were asked to answer a questionnaire after their consent. The diagnosis of GAD and PD were assessed by the “Mini International Neuropsychiatric Interview” of the DSM-IV. Depressive symptoms were evaluated using the “Beck Depression Inventory” (BDI).

Results

The average age was 39 years. The sex ratio M/F was 1/2.

The GAD was diagnosed in 10.8% of participants. The mean IDB score was 3.8. According to this scale, a mild depression was noted in 23.6%, moderate 12% and severe in 2.8% of cases. The GAD was statistically associated with psychiatric histories (P = 0.009), particularly depression disorder (P = 0.004) and the history of suicide attempt (P < 0.001).

The IDB score was significantly higher in participants with GAD (P < 0.001). Among them, 74% presented moderate to severe depression.

GAD co-occurs with PD in 22.2% of cases. This association was statistically significant (P < 0.001). Participants presenting GAD- PD comorbidity are at higher risk of developing depression (P = 0.003).

Conclusion

One must always think to screen comorbidities in the presence of either diagnosis, in order to ensure a better management.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

What do Tunisian General Practitioners Know About Insomnia?

Introduction

Insomnia is the most prevalent sleep disorders and affects 10% of adults worldwide. It has major social and economic consequences. The aim of our study was to evaluate the knowledge of Tunisian general practitioners (GPs) about insomnia.

Methods

A cross-sectional survey was carried out during the month of May 2016. Among the 193 GPs randomly selected from different areas of Sfax, in Tunisia, 127 participated to the study. The latter filled a questionnaire including items related to socio-demographic data and clinical features of insomnia.

Results

Among our participants, 58.3% (n = 74) were men and 41.7% (n = 53) women. The average age was 47.91 ± 10.1 years. They have been working for 17.36 ± 10.7 years on average. Seventy-six of GPs had an individual training and a training by attending conferences or by continuous medical education. Most participants (80.3%) thought that they had some lacuna in the management of insomnia. Specific recommendations for the management and treatment of insomnia were known by 7.2% of the GPs. As for theoretical knowledge about insomnia, 74.8% of participants (n = 95) had a high score of correct answers. The latter was correlated to age (P = 0.013) and to the male gender (P = 0.008). However, it was neither correlated to the seniority of the GPs (P = 0.051) nor to the knowledge of specific recommendations for the management of insomnia (P = 0.11).

Conclusion

Our results showed that the GPs had a rather good theoretical knowledge about insomnia. Yet, an improvement of the continuous medical education and a better knowledge of specific recommendations for the management of insomnia are needed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Chronic benzodiazepine use in aged patients with depressive disorder

Objective

To identify predictive variables of chronic benzodiazepine use among elderly patients with depressive disorder.

Methods

This was a cross-sectional, descriptive and analytical study, including 41 patients suffering from depressive disorders, aged 65 years or more, treated with benzodiazepine (BZD) and followed-up in outpatient psychiatry unit at Hedi Chaker university hospital in Sfax in Tunisia. We used a standardized questionnaire including socio-demographic and clinical data. Chronic BZD use was defined as BZD availability at least 50% of the days between day 181 and day 365 following initiation.

Results

The average age of patients was 69.29 ± 5.7 years. The sex ratio (M/F) was 0.5. The majority of them were married (78%), unemployed (82.9%) and living in urban area (61%). They had at most a primary degree (90.2%) and a low socioeconomic level (63.4%). The average time of BZD consumption was 4 years and 5 months.

The prevalence of chronic BZD use in our sample was 56.1%. Duration of benzodiazepine use was greater than 1 year for all chronic BZD users. The mean dose of Benzodiazepine (Lorazepam) consumed was 3.87 ± 2.8 mg per day. Chronic BZD use was correlated with low socioeconomic level (86.3% vs 36.8%; P = 0.000), psychiatric comorbidity (72.7% vs 26.3%; P = 0.004) and recent hospitalization (59% vs 15.7%; P = 0.023).

Conclusion

There is a high prevalence of chronic BZD use in our study. For the 65 years and older patients with depressive disorder, significant predictors of chronic BZD use were low socioeconomic level, psychiatric comorbidity and recent hospitalization.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Opuntia ficus-indica cladodes as a functional ingredient: bioactive compounds profile and their effect on antioxidant quality of bread

Background

In the context of a balanced diet, the antioxidant-rich food consumption is a preventive way of many degenerative diseases. Consequently, improving the nutraceutical quality of traditional foods such as bakery products is an interesting approach. Considering the present consumer’s demand, cladodes from prickly pear that were traditionally used as a valuable food as well as in folk medicine for the treatment of several chronic diseases were investigated for their use in bread production to improve its functionality.

Methods

Bioactive substances were determined by liquid chromatography-high resolution electrospray ionization mass spectrometry (LC-HRESIMS) analysis. Dough rheological properties were characterized by alveographic measurements. Bread antioxidant quality was evaluated by total phenolics content, DPPH• radical-scavenging, metal (Fe²⁺) chelating and Fe³⁺ reducing power determinations.

Results

LC-HRESIMS analysis of the cladodes extract allowed the identification of 9 flavonoids, 2 phenolics, 1 alkaloid and 1 terpenoid compounds. Cladodes powder enrichment induced important modifications on the dough rheological parameters in terms of the extensibility (L) and deformation energy (W) decrease. Moreover, cladodes powder addition to bread resulted in a decrease in both crust and crumb colour parameters (L*, a* and b*). A 5% supplementation resulted in an increase of the bread yield and bread specific volume by 8.9 and 25%, respectively. Interestingly, Bread containing cladodes powder showed enhanced total phenolics content and antioxidant potential as compared to the control.

Conclusions

Substitution of wheat flour by the cladodes powder at 5% level was optimal for improving the total phenolics content and the antioxidant potential of bread without having any negative effect on its sensory acceptability. Cladodes from Opuntia ficus-indica could be considered as a potential health-promoting functional ingredient in bakery products.

Lithium induced, oxidative stress and related damages in testes and heart in male rats: The protective effects of Malva sylvestris extract

Malva sylvestris is widely used in Mediterranean and European traditional medicine and ethnoveterinary for the treatment of various diseases. This study, carried out on male Wistar rats, evaluates the beneficial effects of Malva sylvestris extract upon lithium carbonate-induced damages in testes and heart. For this purpose, Malva sylvestris extract at a dose of 0.2g/kg was orally administrated, followed by 25mg/kg lithium carbonate (intraperitoneal injection, twice daily). Lithium carbonate treatment significantly (p<0.01) decreased the weight of testes, accessory sex organ and heart, sperm count and motility, and serum testosterone level. In addition, exposure to lithium carbonate significantly (p<0.01) increased lipid peroxidation level (LPO) and decreased superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) activities in testes and heart. Treatment with M. sylvestris extract affords substantial protection in testes and heart by altering all the parameters to near normal levels that were further confirmed by histological examination. The beneficial effect of M. Sylvestris extract in several organs could be attributed to the interaction of antioxidant components, such as complex polysaccharides, as confirmed by phytochemical analysis.

Anti-inflammatory and anti-proliferative activities of the wild edible cruciferous: Diplotaxis simplex

Context The present study deals with new biological properties of the wild edible Diplotaxis simplex (Viv.) Spreng (Brassicaceae). Objectives The current study evaluates the antioxidant, the anti-inflammatory and the anti-cancer properties of ethyl acetate and ethanol extracts from D. simplex flowers. Materials and methods The anti-proliferative activity of the extracts (10-70 μg/mL) was assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) against human colon cancer cell line Caco-2. The anti-inflammatory potential was evaluated by the inhibitory effect of the extracts (1.5-7.5 mg/mL) on phospholipase A2 activity as well as on carrageenan-induced paw oedema in mice. Extracts (200 mg/kg) or indomethacin (50 mg/kg) as positive control were injected intraperitoneally for albino mice prior to the induction of the oedema by carrageenan. Antioxidant activities were investigated using various complementary methods. Results Flower extracts contained a high level of polyphenolics (17.10-52.70 mg GAE/g) and flavonoids (74.20-100.60 mg QE/g), which correlate with its appreciable antioxidant potential in β-carotene peroxidation (IC50 value: 12.50-27.10 μg/mL), DPPH(•) radical-scavenging (IC50 value: 0.20-0.40 mg/mL), Fe(3+ )reducing (EC50 value: 0.10-0.14 mg/mL) and Fe(2+ )chelating (IC50 value: 0.20-0.60 mg/mL) assays. These extracts were effective in inhibiting cancer cell growth (IC50 value: 62.0-63.25 μg/mL). Besides, the ethyl acetate extract inhibited phospholipase A2 activity (IC50 value: 2.97 mg/mL) and reduced the paw oedema in mice (from 0.38 ± 0.01 to 0.24 ± 0.01 cm), 4 h post-carrageenan challenge. Conclusion These data suggest that D. simplex may be useful as a candidate in the treatment of inflammation and the colon cancer.