Enhancing the Bioavailability of Resveratrol: Combine It, Derivatize It, or Encapsulate It?

Overcoming the limited bioavailability and extensive metabolism of effective in vitro drugs remains a challenge that limits the translation of promising drugs into clinical trials. Resveratrol, despite its well-reported therapeutic benefits, is not metabolically stable and thus has not been utilized as an effective clinical drug. This is because it needs to be consumed in large amounts to overcome the burdens of bioavailability and conversion into less effective metabolites. Herein, we summarize the more relevant approaches to modify resveratrol, aiming to increase its biological and therapeutic efficacy. We discuss combination therapies, derivatization, and the use of resveratrol nanoparticles. Interestingly, the combination of resveratrol with established chemotherapeutic drugs has shown promising therapeutic effects on colon cancer (with oxaliplatin), liver cancer (with cisplatin, 5-FU), and gastric cancer (with doxorubicin). On the other hand, derivatizing resveratrol, including hydroxylation, amination, amidation, imidation, methoxylation, prenylation, halogenation, glycosylation, and oligomerization, differentially modifies its bioavailability and could be used for preferential therapeutic outcomes. Moreover, the encapsulation of resveratrol allows its trapping within different forms of shells for targeted therapy. Depending on the nanoparticle used, it can enhance its solubility and absorption, increasing its bioavailability and efficacy. These include polymers, metals, solid lipids, and other nanoparticles that have shown promising preclinical results, adding more "hype" to the research on resveratrol. This review provides a platform to compare the different approaches to allow directed research into better treatment options with resveratrol.

Moderating effect of work fatigue on the association between resilience and posttraumatic stress symptoms: a cross-sectional multi-country study among pharmacists during the COVID-19 pandemic

INTRODUCTION

In the context of the COVID-19 pandemic, pharmacists, despite their vital contributions, have faced significant challenges that have impacted their mental well-being, potentially leading to the development of Post-Traumatic Stress symptoms (PTSS). The aim of this study was to investigate the role of work-related fatigue as a potential moderator in the relationship between pharmacists' resilience and their likelihood of experiencing PTSS during the COVID-19 pandemic.

METHODS

A cross-sectional survey was conducted online in eight countries from January to December 2021, including Brazil, Lebanon, Nigeria, Pakistan, Poland, Serbia, and Tunisia. The mediation analysis was conducted using PROCESS MACRO (an SPSS add-on) v3.4 model 1, taking work fatigue as a moderator in the association between resilience and PTSS.

RESULTS

A total of 442 pharmacists were enrolled in this study (mean age = 33.91 ± 10.36 years) with 59.5% of them being females. The results were adjusted over country, gender, working in contact with COVID-19, working patients, working mandatory hours, working voluntary hours, age, household crowding index and number of months engaged in COVID-19. The interactions resilience by physical (Beta = 0.02; p = .029), mental (Beta = 0.02; p = .040) and emotional (Beta = 0.03; p = .008) work fatigue were significantly associated with PTSS; for pharmacists with low to moderate levels of physical (Beta = - 0.33; p < .001 and Beta = - 0.21; p = .001), mental (Beta = - 0.29; p < .001 and Beta = - 0.18; p = .006) and emotional (Beta = - 0.31; p < .001 and Beta = - 0.17; p = .008) work fatigue, higher resilience was significantly related to lower PTSS levels. However, for pharmacists with high levels of physical/mental/emotional work fatigue, the association between resilience and PTSS became non-significant.

CONCLUSION

This study highlights the complex relationship between work-related fatigue, resilience, and PTSS in pharmacists. It emphasizes the need to address work-related fatigue for pharmacists' psychological well-being during crises, offering insights for tailored support and interventions.

Comprehension of prescription orders with and without pictograms: tool validation and comparative assessment among a sample of participants from a developing country

BACKGROUND

Medication errors can often occur due to the patient's inability to comprehend written or verbal medication orders. This study aimed to develop pictograms of selected medication orders and to validate the comprehension of prescription orders index and compare the comprehension scores with and without pictograms. In addition to determine the predictors that could be associated with a better or worse comprehension of prescription orders with pictograms versus that of their written counterparts.

METHODS

A cross-sectional study was conducted using a snowball sampling technique. Six pictograms were developed to depict specific medication orders. The comprehension of prescription orders index was constructed and validated. The study then compared the comprehension scores of prescription orders with and without pictograms, and identified the predicting factors score difference.

RESULTS

A total of 1848 participants were included in the study. The structure of the comprehension of prescription orders index was validated over a solution of four factors, with an adequate Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy of 0.711 and a significant Bartlett's test of sphericity (P < 0.001). The construct validity of the index was further confirmed by highly significant correlations between each item and the full index (P < 0.001). The study also found a significant association between the difference in comprehension scores for prescription orders with and without pictograms and several factors, including age, level of education, area of residence, number of children, and smoking status with the difference of comprehension scores (P < 0.001).

CONCLUSION

Pictogram-based instructions of medication orders were better understood by the Lebanese population than written instructions, making the incorporation of pictograms in pharmacy practice paramount to optimize medication use by the patient and thus yielding better health outcomes.

Schizophrenia-Like Psychotic Symptoms Associated to Leigh Syndrome

Introduction

Leigh syndrome (LS) is a mitochondrial disease characterized by subacute necrotizing encephalomyelopathy with an estimated incidence of 1:40,000 births. The comorbidity of psychotic symptoms noted in mitochondrial and psychiatric diseases has spurred interest in the effects of DNA mutations and psychiatric disorders. Case presentation. We report the case of a Tunisian 28-year-old male diagnosed with maternally inherited Leigh syndrome. He presented anxiety and auditory hallucinations, and he reported a vague, unsystematized delusion evolving since 6 months. Significant remission was observed at risperidone 3 mg/day. Discussion. The normality of explorations in our case raised the issue of the link between the two diseases, supporting the hypothesis that mitochondrial dysfunction maybe the primary origin of psychotic disorders.

Conclusion

The aim of our work is to study the relations between mitochondrial dysfunction and psychiatric symptoms. Further study of mitochondrial dysfunction in psychiatric disorders is expected to be useful for the development of cellular disease markers and new psychotropics.

Exploring the effects of health behaviors and mental health on students' academic achievement: a cross-sectional study on lebanese university students

BACKGROUND

High academic achievement, an important determinant of future success, is known to be influenced by many factors including dietary behavior, lifestyle and mental health, among others. The objectives of the current study were to explore university students' nutritive habits, daily lifestyle, and mental status, and to scrutinize the associations between these factors and students' academic achievement.

METHODS

A cross-sectional study was conducted among students of a private Lebanese university, using an electronic survey. Diet, eating habits, physical activity, sleep, and smoking were evaluated, and mental health was assessed using a validated Arabic version of the combined Depression, Anxiety, Stress Score (DASS-8). Academic achievement was measured using the Subjective Academic Achievement Scale (SAAS).

RESULTS

A total of 1677 students participated in the questionnaire. The results of a linear regression taking the SAAS score as the dependent variable, showed that students who have a non-scientific versus scientific major (Beta = 0.53), and having breakfast ≥ 4 days per week compared to less than 2 days (Beta = 0.28) were significantly associated with higher SAAS scores. More psychological distress (Beta = - 0.06) and a higher number of days of eating out (Beta = - 0.07) were significantly associated with lower SAAS scores.

CONCLUSIONS

This is the first investigation on a Lebanese university students' academic success in relation to lifestyle and mental profiles. Better academic achievement was demonstrated by students having healthier dietary and lifestyle habits, as well as less distressing mental status. Such results, in light of the compounded and unprecedented crises with which Lebanon has been assailed, suggest the need to focus on promoting healthy habits among students in higher education as a possible driver of better academic success.

Factors Affecting Influenza Vaccination Uptake and Attitudes among Lebanese University Students: The Impact of Vaccination Promotional Programs and COVID-19 Pandemic

Vaccination is the most effective preventative strategy against influenza, yet university students' influenza vaccination uptake remains low. This study aimed firstly to determine the percentage of university students who were vaccinated for the 2015-2016 influenza season and to identify reasons for non-vaccination, and secondly to examine the impact of external factors (on-campus/online influenza awareness campaigns and COVID-19 pandemic) on their influenza vaccination uptake and attitudes for the 2017-2018 and 2021-2022 influenza seasons. A descriptive study was conducted over three phases for three influenza seasons at a Lebanese university in the Bekaa Region. Based on data collected in 2015-2016, promotional activities were developed and implemented for the other influenza seasons. This study was conducted using an anonymous, self-administered questionnaire by students. The majority of the respondents in the three studies did not receive the influenza vaccine (89.2% in the 2015-2016 study, 87.3% in the 2017-2018 study, and 84.7% in the 2021-2022 study). Among the unvaccinated respondents, the main reason for non-vaccination was that they thought that they did not need it. The primary reason for vaccination among those who were vaccinated was that they believed they were at risk of catching influenza in a 2017-2018 study and due to the COVID-19 pandemic in the 2021-2022 study. As for attitudes towards influenza vaccination post-COVID-19, significant differences were shown among the vaccinated and unvaccinated respondents. The vaccination rates among university students remained low despite of the awareness campaigns and COVID-19 pandemic.

Potassium Ion Channels in Glioma: From Basic Knowledge into Therapeutic Applications

Ion channels, specifically those controlling the flux of potassium across cell membranes, have recently been shown to exhibit an important role in the pathophysiology of glioma, the most common primary central nervous system tumor with a poor prognosis. Potassium channels are grouped into four subfamilies differing by their domain structure, gating mechanisms, and functions. Pertinent literature indicates the vital functions of potassium channels in many aspects of glioma carcinogenesis, including proliferation, migration, and apoptosis. The dysfunction of potassium channels can result in pro-proliferative signals that are highly related to calcium signaling as well. Moreover, this dysfunction can feed into migration and metastasis, most likely by increasing the osmotic pressure of cells allowing the cells to initiate the "escape" and "invasion" of capillaries. Reducing the expression or channel blockage has shown efficacy in reducing the proliferation and infiltration of glioma cells as well as inducing apoptosis, priming several approaches to target potassium channels in gliomas pharmacologically. This review summarizes the current knowledge on potassium channels, their contribution to oncogenic transformations in glioma, and the existing perspectives on utilizing them as potential targets for therapy.

[COVID-19 Pandemic: Psychosocial impact among healthcare professionals in Tunisia]

OBJECTIVE

To determine the psycho-affective impact of the Covid-19 pandemic on the mental health of health professionals in Tunisia and to estimate the associated factors.

METHODS

This is a multicenter, cross-sectional, descriptive and analytical study of health professionals carried out from May 2, 2020 to June 30, 2020 in Tunisia. Healthcare professionals included doctors, nurses, dentists and pharmacists. The participants answered a pre-established questionnaire using an electronic "Google Form". This questionnaire gathered demographic data and medical history. It included two psychometric scales, the GAD-7 (General Anxiety Disorder-7) and the PHQ-9 (Patient Health Questionnaire-9) to assess the prevalence and intensity of anxiety symptoms and depressive symptoms respectively.

RESULTS

The study included 203 healthcare professionals. The professionals had a mean age of 30.74±6.33years, 69.5 % were women, and the majority were doctors (77.8 %). Among professionals, 9.4 % were nurses, 7.4 % were dentists, and 5.4 % were pharmacists. A third of the participants 34.3 % worked in departments with Covid-19 patienfor having moderate to severe anxiety symptoms.

CONCLUSION

In order to ensure better patient care, early detection of psychiatric disorders and the implementation of specific strategies to ensure better mental health among healthcare professionals are priorities not only during the current pandemic but also in the event of a future similar pandemic.

Knowledge, Attitude and Conspiracy Beliefs of Healthcare Workers in Lebanon towards Monkeypox

The emergence of a monkeypox (MPOX) outbreak in 2022 represented the most recent recognizable public health emergency at a global level. Improving knowledge and attitude towards MPOX, particularly among healthcare workers (HCWs), can be a valuable approach in public health preventive efforts aiming to halt MPOX virus spread. The aim of the current study was to evaluate the knowledge and attitude of HCWs in Lebanon towards MPOX and to assess their conspiratorial attitude towards emerging virus infections (EVIs). The current study was based on a cross-sectional online survey distributed via Google Forms during September-December 2022 implementing a convenience sampling approach. The final study sample comprised a total of 646 HCWs: physicians (n = 171, 26.5%), pharmacists (n = 283, 43.8%), and nurses (n = 168, 26.0%), among others (n = 24, 3.7%). Variable defects in MPOX knowledge were detected, with a third of the participants having MPOX knowledge above the 75th percentile (n = 218, 33.7%). Satisfactory attitude towards MPOX (>75th percentile) was observed in less than a third of the participants (n = 198, 30.7%), while a quarter of the study sample endorsed conspiracy beliefs towards EVIs at a high level (>75th percentile, n = 164, 25.4%). Slightly more than two thirds of the participants agreed that MPOX vaccination should be used in disease prevention (n = 440, 68.1%). Better levels of MPOX knowledge and attitude were significantly associated with postgraduate education and older age. Physicians had significantly higher MPOX knowledge compared to other occupational categories. Less endorsement of conspiracies towards EVIs was significantly associated with male sex, occupation as a physician, and postgraduate education. Higher MPOX knowledge was associated with better attitude towards the disease. The current study showed unsatisfactory MPOX knowledge among Lebanese HCWs. Educational efforts can be valuable to improve the attitude towards the disease. Despite the relatively low level of embracing conspiracy beliefs regarding EVIs among HCWs in this study compared to previous studies, this area should be considered based on its potential impact on health-seeking behavior.

The impact of COVID-19 on the mental health of Lebanese pharmacists: A national cross-sectional study

Introduction

The COVID-19 pandemic has induced a global mental health crisis with variable consequences. This study aimed to assess the psychological impact of COVID-19 regarding anxiety, insomnia, depression, and response to trauma on pharmacists in Lebanon during COVID-19, and to identify factors contributing to psychological distress.

Methods

This was a cross-sectional study among pharmacists that involved the use of the 7-item Generalized Anxiety Disorder (GAD-7), 7-item Insomnia Severity Index (ISI), Patient Health Questionnaire 9-item depression module (PHQ-9), and Impact of Event Scale revised (IES-R) subscales. Descriptive statistical analyses were performed to determine the study distribution. The associations between the scores and the participants' characteristics were assessed using the Chi-square test. Four binary logistic regression models were used to evaluate the association between the scores and the potential confounders, followed by four multivariable logistic regressions. An alpha of 0.05 was used to determine statistical significance.

Results

Participants comprised 311 pharmacists from all Lebanese districts, of whom 251 (80.7%) were females and 181 (58.2%) aged between 26 and 35 years. The majority of the participants were community pharmacists (n = 178, 57.2%). A considerable proportion of participants had symptoms of anxiety (n = 128, 41.2%), insomnia (n = 64, 20.6%), depression (n = 157, 50.5%), and subjective stress (n = 227, 78.8%). Higher anxiety (aOR: 1.73, 95% CI: 1.08; 2.78, p-value: 0.02), higher depression (aOR: 3.06, 95% CI: 1.73; 5.39, p-value: 0.001), and higher stress (aOR: 1.86, 95 percent CI: 1.11; 3.14, p-value: 0.02) scores were significantly associated with pharmacists who reported that their work involves contact with infected/suspected COVID-19 patients. Interestingly, pharmacists who expressed concern about contracting COVID-19 infection had significantly higher anxiety (aOR: 2.35, 95% CI: 1.40; 3.94, p-value: 0.001) and higher depression scores (aOR: 2.64, 95% CI: 1.49; 4.67, p-value: 0.001) respectively.

Conclusion

The preliminary results from pharmacists in Lebanon reflect increase in stress, burden, and frustration felt by pharmacists, creating a negative impact on their mental health and well-being during the global pandemic. As frontline healthcare workers, the role of pharmacists in the community should not be overlooked, and their mental health should be well investigated.

Knowledge, Attitude, and Practice in a Sample of the Lebanese Population Regarding Cholera

The evaluation of knowledge, attitude, and practices towards an emerging disease is an essential component of public health preventive measures during an outbreak. In October 2022, an outbreak of cholera was reported in Lebanon, which is the first to be reported in the Middle Eastern country for 30 years. This study aimed to explore the level of knowledge as well as attitude and practice of the general public in Lebanon towards cholera. A self-administered structured questionnaire was distributed via an online link to individuals living in Lebanon during October-November 2022. The survey instrument comprised items to assess the sociodemographic data; questions on knowledge about cholera symptoms, transmission, and prevention; as well as attitude and practice questions. Our study involved 553 participants, with a median age of 24 years and a majority of females (72.5%). The results showed that the majority of respondents correctly identified diarrhea as a symptom of cholera and recognized the spread via contaminated water and food. Having a university level education compared with secondary school or less (adjusted odds ratio (aOR) = 2.09), being married compared with single (aOR = 1.67), and working in the medical field compared with unemployed (aOR = 4.19) were significantly associated with higher odds of having good cholera knowledge. Having good knowledge compared with having a poor level of cholera knowledge (aOR = 1.83) and older age (aOR = 1.03) were significantly associated with higher odds of having a good attitude towards cholera. The current study showed an overall high knowledge score on cholera among the Lebanese population. Nevertheless, gaps in cholera knowledge were identified and should be addressed, particularly among workers in the medical field. Thus, we recommend targeted health education to the general population that aims to strengthen the health resilience in the community.

Allylamines, Benzylamines, and Fungal Cell Permeability: A Review of Mechanistic Effects and Usefulness against Fungal Pathogens

Allylamines, naftifine and terbinafine, and the benzylamine, butenafine, are antifungal agents with activity on the fungal cell membrane. These synthetic compounds specifically inhibit squalene epoxidase, a key enzyme in fungal sterol biosynthesis. This results in a deficiency in ergosterol, a major fungal membrane sterol that regulates membrane fluidity, biogenesis, and functions, and whose damage results in increased membrane permeability and leakage of cellular components, ultimately leading to fungal cell death. With the fungal cell membrane being predominantly made up of lipids including sterols, these lipids have a vital role in the pathogenesis of fungal infections and the identification of improved therapies. This review will focus on the fungal cell membrane structure, activity of allylamines and benzylamines, and the mechanistic damage they cause to the membrane. Furthermore, pharmaceutical preparations and clinical uses of these drugs, mainly in dermatophyte infections, will be reviewed.

Motivation, satisfaction, and future career intentions of pharmacy students: A cross-sectional preliminary analysis

INTRODUCTION

In recent years, the pharmacy profession has undergone many changes that impacted pharmacy educational programs and students' needs and experiences. In Lebanon, no previous studies have addressed students' perspectives of pharmacy studies and their future aspirations.

METHODS

A cross-sectional survey was randomly sent to all pharmacy students at the main campus of the Lebanese International University. Questions included demographics, students' reasons for choosing pharmacy, satisfaction regarding choice of pharmacy, and future career plans.

RESULTS

Pharmacy as a study major was the first choice for 61% of respondents, and reasons for this choice were family recommendations (87%), friends' encouragement (26%), and schoolteachers' endorsements (20%). Looking for a job with various career opportunities, flexible working hours, security, good salary, and wishing to provide public service and improve health were the main incentives to join the pharmacy program. Concerning their satisfaction, 88% were proud of studying pharmacy and 66% would choose to study pharmacy if they were to select their program of study again. As for career intentions, 68% were considering community pharmacy, 66% hospital pharmacy, and 60% academic pharmacy.

CONCLUSIONS

While the attitudes, perceptions, and career intentions of the respondents were variable, the majority were aspired by family or societal factors to study pharmacy, were satisfied by their choice, and intended to work in the community pharmacy sector. Pharmacy curricula should be regularly assessed to meet students' expectations and society's needs.

Chronic kidney disease awareness among the general population: tool validation and knowledge assessment in a developing country

Introduction

Good knowledge and early identification of chronic kidney disease (CKD) can help in preventing disease progression in its early stages and reducing undesired outcomes. The aim of the current study was to assess the level of public knowledge about CKD, determine predictors of better knowledge, and to construct and validate a CKD knowledge scale for public health assessment and research use.

Methods

A community-based cross-sectional study was conducted using an electronic self-administered questionnaire. All people living in Lebanon and being 18 years of age and above were considered eligible for recruitment. CKD knowledge was assessed by a 37-item scale that was constructed by principal component analysis and then validated. The score of the CKD knowledge scale was computed from the extracted factors. A multivariable binomial logistic regression model evaluated the sociodemographic and clinical predictors of the knowledge score.

Results

A total of 1308 participants were included. The scale items converged over 9 factors with Eigenvalue greater than 1 and explaining 53.26% of the total variance, and the total scale had a high Cronbach’s alpha of 0.804. All items of the scale significantly correlated with the full scale with correlation coefficients ranging from 0.082 to 0.558. The ROC curve analysis determined an optimal cutoff point of better knowledge at 47.5 with 70.6% sensitivity and 44.2% specificity. The CKD knowledge score had a median of 51.00 (IQR 47.00–55.00). Higher knowledge score was significantly associated with old age (ORa = 1.018, 95% CI 1.006–1.030, P = 0.003),, occupation (ORa = 3.919, 95% CI 2.107–7.288, P <  0.001), and recent renal function assessment (ORa = 2.314, 95% CI 1.532–3.495, P <  0.001). However, a lower knowledge score was significantly associated with lower level of education (ORa = 0.462, 95% CI 0.327–0.653, P <  0.001).

Conclusion

A reliable tool to assess public knowledge and awareness about CKD was developed and validated. The overall knowledge was good, however, important gaps in CKD awareness were detected in some areas and subpopulations. Therefore, public health stakeholders need to implement targeted CKD educational activities to minimize the disease burden.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12882-022-02889-2.

Covid -19 pandemic‘s impact on the clinical presentation of brief psychotic disorders

Introduction

A major increase in mental health issues was noted since the outbreak of the covid-19 pandemic even in patients with no history of mental health illness, specifically brief psychotic disorders.

Objectives

Establish the covid-19 pandemic circumstances as precipitating factors of psychosis independently from other stressors

Methods

This is a cross-sectional and descriptive study carried out in the psychiatric department of the University Hospital of Mahdia including two groups of patients over a period of 15 months: From October 2018 to December 2019 are pre-covid cases, and the second group consists of the ones admitted between June 2020 and August 2021. We have collected the data of patients diagnosed with brief psychotic disorder according to DSM-5. We have focused on two clinical characteristics of the psychotic episodes (theme of delusions, stressors).

Results

We have collected 19 patients, 12 among them during the pre-covid period. In our pre-covid period, brief psychotic disorder presented mostly with marked stressors (33.3%) whilst in the middle of the pandemic, marked stressors are present in only 14.3% of the cases. Which could suggest that this state of alarm can singlehandedly trigger psychosis. For the theme of delusions, in the pre-covid period, the religious theme appeared to be the most frequent (58.3%), whilst during the pandemic, persecution became the most prevalent (71.4%), showing how living in fear of contracting the virus could manifest itself in delusional content.

Conclusions

Living in a prolonged state of alarm is, in itself, a marked stressor, theoretically capable of increasing the psychosis rate and altering its characteristics.

Disclosure

No significant relationships.

Impact of the Covid-19 pandemic on people with a pre-existing psychiatric disorder

Introduction

The Covid-19 pandemic has had a deleterious impact on populations across the world. Yet it remains unclear how this pandemic is affecting the psychological health of people with a previous history of mental illness.

Objectives

This study aims to investigate the impact of Covid-19 on patients with established mental disorders.

Methods

The PubMed and science direct databases were systematically searched using the keywords combination “Covid-19” and “psychiatric disorders”, “the pandemic” and “mental disorders “, from inception up to November 2021. We adopted a broad inclusion criterion for the study requiring patients to have a pre-existing mental disorder, excluding narrative reviews and preclinical studies. In addition, a search of google scholar was conducted to identify any additional relevant publications.

Results

We have found 26 studies but only 19 met our inclusion criteria. Included studies were published between 2020 and 2021. 2 major results were identified. Symptoms deterioration was reported in individuals with severe mental disorders and those with schizophrenia in particular, such as depressive or anxiety symptoms, substance use and suicidal ideation, due to the psychological stress and physical distancing measures associated with the Covid-19 outbreak. The symptomatic treatments used in Covid-19 had frequent interactions with the most used antipsychotic drugs leading to a substantial increase in relapse rates in people with mental disorders.

Conclusions

The Covid-19 pandemic has a serious impact on individuals with pre-existing mental illness reinforcing symptom severity and psychological stress. Additional studies are needed to strengthen current findings with pre-pandemic records.

Disclosure

No significant relationships.

Mental Confusion of Neurological Etiology in 41 cases

Introduction

The confusional state is the clinical expression of a temporary acute cerebral decompensation. It is expressed by a global, fluctuating and reversible alteration of cognitive functions. It is a frequent reason for consultation in the emergency room.

Objectives

To determine the epidemiology, neurological etiologies and their risk factors.

Methods

Retrospective study based on the files of 41 hospitalized patients with confusional syndrome.

Results

We collected 41 patients. The mean age was 72.9 years. The sex ratio was 1.25. The antecedents found were arterial hypertension and diabetes in 10 patients, a history of stroke was ischemic in 21 cases and hemorrhagic in 6 cases, cerebral metastasis in 5 cases, hepatic encephalopathy in 6 cases and a toxic cause in 4 cases. Mental confusion was acute in 23 patients and subacute in 18. The confusional manifestations observed were essentially temporospatial disorientation in 27 patients, obnubilation in 22 cases, difficulty in paying attention and concentrating in 24 cases, and vague and slow verbal expression in 11 cases. A metabolic disorder was found in 15 patients, such as hyperkalaemia (7 cases) and hyperglycaemia (8 cases). Etiological treatment was instituted with recourse to sedative treatment in 18 patients due to agitation. The evolution was marked by a total regression of confusion in 11 cases, lacunar amnesia in 7 cases, prolonged mental confusion in 6 cases and death in 3 patients.

Conclusions

Elderly subjects are at risk due to the vulnerability of brain structures to pathologies and treatments associated with this period of life. Early treatment can improve the prognosis.

Disclosure

No significant relationships.

AB0642 Diagnosis of Cerebral vasculitis: retrospective study of 68 cases

Background

Cerebral vasculitis, whether primary or secondary, is a group of heterogeneous pathologies characterized by a destructive inflammatory vascular wall lesion of the cerebral tissue. Its physiopathology remains poorly understood. Clinical polymorphism is a major characteristic of this disease.

Objectives

The aim of this work was to describe the epidemiological, clinical, radiological and etiological aspects of Cerebral vasculitis.

Methods

We conducted a retrospective descriptive study based of the records of 68 patients who were hospitalized in the Internal Medicine and Neurology Departments of the Taher Sfar University Hospital in Mahdia over a 12-year period from January 2008 to June 2021.

Results

A total of 68 patients were included: 46 female and 22 male (sex-ratio M/F: 0.47) with an average age of 50.8 ±12.7 [15-75 years]. The revealing symptoms were: Headaches in 52 patients (79.9%) followed by motor deficit in 21 patients (30.8%), sensitivity disorder in 24 patients (35.3%) and neurosensory disorders in 24 patients (35.3 %). These symptoms were insidious in 41 patients (61.2%). The neurological examination was pathological in 75 % of the patients, among them 19 patients (28.7%) had a walking disorder. Strokes were the revealing complication in 5 patients (7%).

Laboratory tests revealed an inflammatory syndrome in 37 patients (55.2%). The lumbar puncture was performed in 76.5% of cases. Cerebral spinal fluid showed aseptic meningitis in 5 cases and High protein level in 6 patients. The immunologic investigations showed that Antinuclear antibodies (ANA) were positive in 41 % and antiphospholipid antibodies were positive in 7.3%.

Cerebral Magnetic Resonance Imagining (MRI) revealed multiple patchy lesions hyperintense on T2 and FLAIR in the white matter in all cases: bilateral and asymmetric in 55 patients (80.9%) with subcortical distribution in 63% and periventricular localization in 45 %. Three patients had Leptomeningeal enhancement.

The etiologies of cerebral vasculitis were: Sjogren Syndrome in 33.8 %, Systemic lupus Erythematosus in 22%, Behcet disease in 19.1 %, Giant cell arteritis in 7.3%, antiphospholipid syndrome in 5.8%, Sarcoidosis in 4.4 %, Susac syndrome in 4.4 % and systemic sclerosis in 2.9 %.

Treatment was based on oral corticosteroids in 89.7 % of cases, associated with intravenous corticosteroids in 52.9% of cases. Immunosuppressive therapy was indicated in 42.4% of patients.

Prompt improvement was obtained in 48,3%, symptoms stability was noticed in 20 %. However, 30% of patients experienced relapse. Worsening of signs was seen in 1.7 %.

Conclusion

Cerebral vasculitis is a rare disorder with a non-specific clinical presentation. Therefore, its diagnosis is a challenge for clinicians who base their investigations on clinical and paraclinical arguments to attribute the neurological and systemic events to vasculitis. An early diagnosis and an appropriate treatment could improve its prognosis.

Disclosure of Interests

None declared

BPA and its analogs increase oxidative stress levels in in vitro cultured granulosa cells by altering anti-oxidant enzymes expression

Bisphenol A is a widespread endocrine disruptor with numerous effects on reproductive functions. Limitations on BPA in manufacturing has prompted the use of analogs, such as BPS and BPF, with limited research on their safety. The objective of this study was to evaluate the effects of BPA and its analogs on oxidative stress levels within bovine granulosa cells and to measure the expression of key antioxidant genes. Results indicate that BPA and BPF reduce cell viability and induce mitochondrial dysfunction and all three bisphenols increased production of reactive oxygen species as early as 12hrs post exposure. BPA increased the levels of antioxidants at 12hrs at the mRNA and protein levels, while these results were not significant at 48hrs. These results together suggest that BPA and its analogs can induce oxidative stress within bovine granulosa cells, although not necessarily through common mechanisms. Therefore, the use of BPA analogs may have to be re-considered.

The psychological impact of the Syrian crisis on refugees living in Lebanon

PURPOSE

This study aims to evaluate the impact of war on Syrian refugees' life in Bekaa/Lebanon, focusing on psychological and physical symptoms, and to assess the prevalence of the most common symptoms of posttraumatic stress disorder (PTSD) in affected patients recruited in the study.

DESIGN AND METHODS

This observational study was conducted over a period of 1 month-June 2019-in three main camps in the Bekaa region. After taking approval, a total number of 108 Syrian refugees were interviewed and asked about their quality of life and health conditions in camps, after leaving their country. A validated questionnaire was filled by field researchers to gather information on refugees' psychological distresses, physical symptoms, and future perspective.

FINDINGS

During the 4 weeks of study, 108 refugees completed the questionnaire; psychological assessment showed 73.8% of refugees who were exposed to the fighting atmosphere, suffered from one or more psychological symptoms related to PTSD. In addition, 50.5% of the refugees were <30 years old, and among those, 83.5% believed that they have no future for themselves and their families, while 15.4% lost hope in a better life. Seventy-four percent reported at least one physical symptom in the past 4 weeks that is related to PTSD. Furthermore, 64.3% strongly agreed that there is lack of awareness and medical care including psychological and mental health, while 56.1% strongly agreed on the important role of pharmacists and other healthcare professionals in providing advice to patients on their overall health and mental health.

CONCLUSION

Syrian refugees at the assessed camps suffered from psychological distress that requires urgent attention. Current medical and psychological support is absent, and further assessment is needed.

Psychiatric symptoms in neurofibromatosis type 2

Introduction

Neurofibromatosis type 2 (NF2) is a rare disorder associated with significant morbidity such as hearing loss that can lead to many psychiatric disorders.

Objectives

Describe the psychiatric symptoms associated to NF2.

Methods

We report the case of a patient admitted to the locked unit of the psychiatric ward for agitation and persecutory delusion and diagnosed with NF2. The data was collected from the patient’s medical file. A review of the literature was performed by selecting articles from PubMed using ‘Psychosis acoustic neuromas’ and ‘Psychosis neurofibromatosis 2’ as key words.

Results

This is the case of a 21-year-old patient who was admitted for behavioral disorders. Our patient had a medical history of a one-sided deafness treated with a hearing prosthesis. He was also followed irregularly by a free-lance psychiatrist. The start of trouble dated back to 3 years marked by behavioral disorders such as fugue, agitation, irritability and sleep disorder. The symptoms worsen in the last 3 months with appearance of hostility and delusion of persecution towards his mother. The patient declines to eat the food that his mother cooked for him and threatened her with a knife. The clinical overview includes delirium, clastic agitation strikes, emotional lability, cerebral ataxia and conjunctival hyperemia. Brain scanner showed an association of bilateral acoustic neuromas, cavernous and intraventricular meningioma. These clinical and radiological signs met the diagnosis for NF2 according to the consensus conference of the National Institute of Health in Bethesda (USA 1988).

Conclusions

The psychiatric symptoms reported in acoustic neuroma patients are usually described as transient.

Catatonia in patients with dementia

Introduction

Catatonia has been reported with almost all types of dementia but it remains under-diagnosed.

Objectives

Describe the characteristics of catatonia in patients with dementia and the efficiency of early management.

Methods

We review a case of a young patient admitted in our psychiatric department for catatonia and after efficient treatment, assessment revealed a dementia.

Results

A 49-year-old male treated with classic antipsychotic drug for an acute psychotic episode at age of 35 years. Three years later, the patient was admitted for behavioral disorders with delirium and confusion. The patient was treated with high-doses of antipsychotic drugs with vasodilator treatment. Currently, ten years later, he was hospitalized in a stuporous state with food refusal, sustained posture and worsening of his overall situation. At the mental assessment, the patient was motionless, mute and rigid with frozen facial expression and gaze stare. Negativity and opposition were obvious against any solicitation. Moreover, the physical examination has shown a worsening of the overall state of health, weight loss and walking difficulties. After symptomatic treatment of catatonia with benzodiazepine, the assessment revealed an aphaso-apraxo-agnotic syndrome with memory dysfunctions such as amnesia with false recognition and executive dysfunction as well as limitations in intellectual abilities. A brain scan revealed cortical and subcortical atrophy predominant in the bilateral fronto-temporo-parietal region associated with ventricular system expansion. The diagnosis of Alzheimer’s disease was made. Following atypical antipsychotic treatment combined with benzodiazepine, there was release of inhibition.

Conclusions

Catatonia is a severe neuropsychiatric syndrome with an excellent prognosis if recognized and treated without delay.

Predictors of poor adherence in schizophrenia

Introduction

Schizophrenia is a chronic mental disorder that requires long-term treatment. Non-adherence to antipsychotics is common and associated with poor outcomes.

Objectives

Our study is aimed to describe the therapeutic adherence and to identify the factors associated with poor adherence among schizophrenic patients.

Methods

This was a cross-sectional study conducted at psychiatry consultation of the university medical center of Mahdia, Tunisia. Data collection occurred between the months of January and March 2018, including patients suffering from schizophrenia. The evaluation of adherence was performed using the MARS scale (Medication Adherence Rating Scale).

Results

In our sample of 131 schizophrenic patients, there is a male predominance (76%), as well as unmarried status (58.7%), unemployed (72%). The rate of non compliance treatment was 73%. Low levels of education, poor insight and polytherapy were associated to poor adherence. Although patients aged more than 40 years, who were married and diagnosed with undifferentiated schizophrenia were good compliant to treatment (p<0.05).

Conclusions

We suggest a proper treatment strategy for each patient based on the identification of non adherence risk factors.

The acting out in patients with Schizophrenia examined in a forensic psychiatric assessment

Introduction

Many studies have shown that schizophrenic patients are responsible for the highest rates of violence among all the mentally ill patients.

Aims of the study

Describe the socio-demographic and clinical characteristics of patients with schizophrenia examined in a forensic psychiatric assessment and identify the risk factors of violence in these patients.

Methodology

A retrospective study carried out in the psychiatric department of university hospital of Mahdia during fifteen years involving 40 patients with schizophrenia examined in a forensic psychiatric assessment following a forensic act. These patients were compared to a population of 40 patients followed in the same establishment for the same disease and without criminal record.

Results

Age average of 36.08 years, male (95%), rural origin (65%), primary level education (47.5%), single (65%), unemployed (65%) and average socio-economic level (65%). Personal psychiatric history (87.5%), personality disorder (12.5%), judiciary history (12.5%) and substance abuse (57.5%). Subtypes of schizophrenia: undifferentiated (52.5%) and paranoid (30%). They have committed serious physical assaults (55%) and aggression against property (27.5%). The victim was mostly a family member (40%), under the influence of toxic (22%), driven by delusions of persecution (61%), with hallucinatory mechanism (55%). The psychiatric expert has concluded an abolition of discernment in 77.5% of cases. Risk factors of acting out were: rural origin, alcohol and psychoactive substances use, productive forms of schizophrenia, poor adherence and irregular monitoring.

Conclusion

The knowledge of risk factors improves the management and allows us better prevention of violence among our patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Acute psychotic disorders: Factors related to schizophrenia evolution

Introduction

Acute psychotic disorders are described as a clinical syndrome characterized by Acuteness of the installation, the intensity and the polymorphism of delirium.

Aim

Describe the demographic characteristics of a population of patients with an acute psychotic disorder and identify factors correlated with evolution to schizophrenia.

Methods

This is a retrospective, descriptive and analytic study conducted on hospitalized patients in psychiatric department EPS Mahdia for acute psychotic disorder according to DSM-VI-TR criteria. A study of the recurrence time was performed by Kaplan–Meier and Cox test was used to identify factors correlated with evolution to schizophrenia.

Results

One hundred and eleven patients were collected. The average age of the study population was 27 years, a male predominance was noted (59.5%), 39.6% of patients had family history of psychiatric disorders, including schizophrenic disorders and bipolar disorder were the most common with rates of 63.6 and 18.4% of cases. For our patients, 38.7% progressed to schizophrenia. Four risk factors were significantly predictive of progression to schizophrenia: male gender (P = 0.026), subacute or progressive onset disorders (P = 0.003), partial remission of the disorder (P = 0.023) and the prolonged duration of untreated psychosis (P = 0.027).

Conclusion

The evolution of an acute psychotic disorder remains unpredictable. In fact, the severity is related to the risk of developing schizophrenia or mood disorder. Attention is paid in recent years to recognize and seek most precociously as possible factors associated with this evolution.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Depression in people with multiple sclerosis

Introduction

Depression is the most common syndrome associated with Multiple Sclerosis (MS) with a high prevalence during a lifetime.

Objectives

To assess the prevalence of depression in patients treated in neurology for MS.

Methods

We performed a retrospective study on 17 patients diagnosed with MS and confirmed with the criteria of Mac Donalds 2010 with a follow-up in the neurology department of the EPS Mahdia for a period of nine years (2006–2014), then addressed to a psychiatric consultation for depression.

Results

In total 17 patients were hospitalised in the neurology department during the study. Ages ranged from 20 to 39 years with an average of 33 years. The average course of the disorder is 5 years. We objectified a female predominance with 82%, a professional activity was found in 76% of patients. The comorbidities found are mainly hypertension, diabetes and asthma, respectively in 11%, 5% and 5%. Depression was clinically confirmed in 9 patients, that to say, 52% of our sample addressed in the psychiatric consultation, whose 6 received an antidepressant (fluoxetine) and 3 received paroxetine. An anxiolytic was given to the half of these patients.

Conclusion

The association between MS and depression would, therefore, be neither fortuitous nor only related to non-specific factors of any chronic disease. Specifying the relative share of these explanatory factors is probably one of the challenges for future researches in this area.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Acute psychotic disorder: Which future?

Introduction

At present, in absence of reliable clinical and evolutionary data, it is difficult to determine what the consequences of an acute psychotic disorder, specifically if it is a mode of entry into schizophrenia, a mood disorder or a short-lived episode.

Aim

The objective of this study was to describe the sociodemographic characteristics and evolutionary modalities of a population of patients with a first psychotic episode.

Methods

This is a retrospective descriptive study, which involved patients admitted to psychiatric ward EPS Mahdia for acute psychotic disorder according to DSM-VI-TR criteria. Data collection was conducted from archived observations and through a predetermined sheet.

Results

One hundred and eleven patients were collected. The average age of the study population was 27 years, a male predominance was noted (59.5%), 52.3% were from urban, 73% of patients were single, 33.3% were from a consanguineous marriage. Among those patients with a first acute psychotic episode, 43 patients (38.7%) progressed to schizophrenia, 15.3% to bipolar disorder, 23, 4% to recovery while 22.5% were lost view.

Conclusion

The long-term evolution of an acute psychotic disorder remains unpredictable. In fact, the severity is related primarily to the risk of developing a schizophrenic disorder or a mood disorder. In this context, attention is paid in recent years to recognize and seek the earliest possible factors associated with this development.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Major Depressive Disorder: Recurrence Risk Factors

Introduction

In spite of the frequency and the gravity of the depressive episodes, the major depressive disorder (MDD) is diagnosed and treated today insufficiently and the risk factors of its recurrence are little approached.

Aims of the study

Describe the socio–demographic, clinical and therapeutic characteristics of patients with MDD and identify the factors involved in the recurrence risk.

Methodology

This is a retrospective study carried out in the university hospital of Mahdia, Tunisia during two years. We have included patients with a follow up for at least two years and diagnosed with MDD, isolated episode or MDD, recurrent episode according to the DSM-IV-TR criteria. Data collection was performed using two pre-established questionnaires respectively with 51 and 92 items. We have estimated the time to recurrence with the Kaplan-Meier estimator.

Results

We have collected 150 patients. The time to recurrence was 109 months. Five factors were associated with recurrence: early age at onset of the disorder, family history of mood disorders, severity of the index major depressive episode, persistent residual symptoms and ceasing treatment.

Conclusion

Depression is a very common mental illness that is highly recurrent in individuals. There is great interest in the development of strategies that might reduce the recurrence of depression.

Hyperinsulinism as evidence of munchausen syndrome by proxy: A case report

Introduction

Hyperinsulinism is one of the most important causes of hypoglycemia. Rarely, drug toxicity can be a reason. In the context of Munchausen syndrome by proxy (MSBP), toxicity usually occurs in children due to drug administration by a parent or caregiver.

Methods

we report a case of a 2-year-old girl with hyperinsulinaemic hypoglycaemia due to insulin injections by her mother.

Case report

Mrs. W. is a 28-year-old mother of three children. In her medical history, she was diagnosed with gestational diabetes and treated briefly with insulin. She was hospitalized several times for hypoglycemia and she was diagnosed with factitious disorder. Lately, her youngest daughter aged 2 years old was hospitalized in the pediatric department for repeated unexplained loss of consciousness. The hospitalization lasted 2 months with recurrence of severe hypoglycemia. A full metabolic screen revealed no abnormalities. The mood of the mother appeared quite discordant with the situation. Strict monitoring of maternal behavior showed that the mother gives insulin injections to her daughter. She denied deliberately injecting insulin, and then she accused the health workers. She was referred to our psychiatric department and we diagnosed the MSBP.

Conclusion

MSBP should be considered particularly in patients who have been evaluated by more than one hospital and have discordant test results.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Acute Psychotic Disorder and Forensic Acts: About 25 Cases

Background

The aim of this study was to identify the socio-demographic status and clinical features of patients with acute psychotic disorder and who committed a medicolegal act, seek acute psychosis implicated and raise the characteristics of this medicolegal acts.

Methods

We performed a retrospective study of 25 male patients with acute psychotic disorder. They were involuntary hospitalized in the medicolegal department of Razi, according to Article 29 of Law after committing a medicolegal act because of dementia within the meaning of article 38 of the Tunisian Penal Code.

Results

It was about a young person, average age of 27.32 years, family cohesion was often present (80%), with forensic history (20%), violence history (20%) and substance abuse (40%), having a personality disorder (25%), having a precipitating factor (32%), having an acute psychotic episode (72%), repetitive acute psychotic episode (16%), a first manic episode (8%) and drug-related psychotic disorder (4%). They had committed by order of frequency serious physical assault (43.5%), attempted murder, assault and injury followed by attacks against property (40%). The victim was mostly a family member (40%), without determination, under the influence of toxic substances (16%) and motivated by delusions of persecution (51%). The acting out was recognized (68%). The majority was indifferent (92%) and does nothing (68%).

Conclusion

The first-episode psychosis have a high-risk of acting out, early treatment may prevent some medicolegal acts. Preventing of acting out in the psychotic involves the identification of risk factors and an early treatment of mental disease.

Disclosure of interest

The authors have not supplied their declaration of competing interest.