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Introduction Patients suffering from psychiatric illness represent a population that is particularly vulnerable to the SARS-CoV-2 virus and to the pandemic situation due to several factors. Objectives We aimed in our study to determine the rate of COVID-19 infection and to identify its correlated factors in outpatients of the psychiatry department of Monastir, Tunisia. Methods This is a descriptive and analytical cross-sectional study conducted on 178 outpatients at the department of psychiatry (Monastir, Tunisia) over a period of one month (from March 2022 to April 2022). Data was collected via a questionnaire focused on two main attributes: (1) sociodemographic and clinical characteristics; (2) questions about the COVID-19 personal and family history. Results The mean age of our population was 44.9±13.7 years. The majority of them (81.5%) had a chronic evolution of their psychiatric disorder (> 2 years) and 68.7% were hospitalized at least once in psychiatry. Psychosis was the most represented disorder with 57.3% compared to mood disorders and anxiety disorders. Among our population, thirty seven patients (21%) had a SARS-CoV-2 infection and 3.1% required hospital care. The infection by the virus of a family member was reported by 46% of cases and 2.5% had intrafamilial death due to COVID-19 disease. Patients with depressive disorder were the most affected (55%). COVID-19 infection was significantly associated with gender (p=0.02), marital status (p=0.016), diagnosis (p=0.001), treatment (p=0.02) and intrafamilial spread of the disease (p

Introduction Consent to care remains the general principle and care without consent must be the exception. However, resorting to care without consent in psychiatry may be indicated when awareness of the disorders or recognition of the need for care is impaired. For this purpose, we have focused on the questions concerning the degree of applicability of this procedure of obligation of care in Tunisia. Objectives The purpose of this study is to describe implementation measures of the obligation of care among patients in the psychiatric department of Monastir. Methods This is a retrospective, descriptive and qualitative study of five patients followed in the psychiatric department at the Fattouma Bourguiba University Hospital of Monastir between January 2020 and August 2022 who were subjects to the obligation of care with reference to Article 30 of Law 92-83 of August 3, 1992, amended by Law No. 2004-40 of May 3, 2004. Results All patients in the study were males. Two out of five patients had a higher level of education. Two patients had a history of family psychiatric disorders. Two patients were being followed for schizophrenia, two others had schizoaffective disorder and one patient had a chronic delusional disorder. Only one patient had a duration of untreated psychosis of 6 years. Most of the patients had been hospitalized once to four times prior to their submission to article 30 of the obligation of care. Only one patient was hospitalized at the request of a third party, four patients were hospitalized by order of the court. Four out of five patients were treated with antipsychotic drugs (delayed-release form). After their submission to article 30, three patients were readmitted for decompensation due to treatment discontinuation, one patient did not consult the doctors, and only one of the five patients was present with his family at his post-treatment appointment. Conclusions what we deduced from our observation encourages us to work better on improving laws and training dedicated to psychiatric practitioners to optimize this judicial and therapeutic practice in our country. Disclosure of Interest None Declared

Introduction The COVID-19 pandemic has created unprecedented challenges for the global health system. In this context, we have suggested as a research hypothesis that during this global health crisis, people with mental disorders, due to the phenomenon of “under medicalization”, would be more affected by Covid infection and would have less chance to be vaccinated. Objectives To calculate the infection rate and vaccination rate for COVID-19 in patients with mental disorders. Methods This is a descriptive and cross-sectional study that took place over a period of one month (from March 2, 2022 to April 2, 2022) and involved patients attending the outpatient department of psychiatry at the Fattouma Bourguiba University Hospital in Monastir. It was conducted using a predeveloped survey with 15 questions exploring sociodemographic characteristics, history of Covid infection (personal infection, hospitalization, infection in the family, death in the family…) and vaccination for Covid-19 and its modalities. Results The medium age of our sample was 44.9 ±13.7 years. The average duration of illness was 12.5 years and the average number of hospitalizations was 1.65. Psychotic disorders were the most represented, 57.1%, compared to mood disorders and anxiety disorders. Twenty-one percent (21%) of patients reported infection with COVID 19 and 3.1% required hospitalization. Forty-six percent (46%) had an infected family member and 2.5% had a death in the family caused by COVID-19. The rate of access to vaccination among our patients was 73.0%. The majority received 2 doses (60.0%), and they were vaccinated on their own initiative (68.0%) and by appointment (71.4%). Conclusions The disability presented by mental disorders, particularly psychotic disorders, can expose patients to marginalization. Indeed, patients with severe mental disorders could constitute a vulnerable population to COVID-19 infection because of their difficulty in accessing care, especially during the COVID-19 pandemic, hence the recommendations. Particular attention must always be paid to patients with mental health disorders, regarding their access to care and the promotion of health for this population. Disclosure of Interest None Declared

Introduction post-traumatic stress disorder (PTSD) is a mental health illness that can develop after being exposed to one or more traumatic events. This is a serious, long-term emotional response to extreme psychological trauma. As for public health emergencies, it demands large-scale coordination among many staff, and participants, especially medical workers, are exposed to high levels of stress, which can easily lead to psychiatric illnesses such as social anxiety disorder (SAD). Posttraumatic stress disorder (PTSD) and social anxiety disorder (SAD) demonstrate a high degree of comorbidity, yet little is known regarding the nature of this relationship. Objectives The aim of this study is to investigate the prevalence of PTSD and SAD among health workers in the emergency ward and study the relationship between PTSD and SAD and the associated factors to both disorders among health workers in the emergency ward to suggest some solutions to reduce their effects. Methods This is a quantitative descriptive cross-sectional study conducted among medical and paramedical health professionals in the emergency rooms of the university hospital of Sahloul and Hached and the regional hospital of Msaken in Tunisia. The data was collected by a questionnaire that included demographic questions and Yes/No questions, as well as several scales to assess the degree of social nxiety (Liebowitz Social Anxiety Scale) and posttraumatic stress disorder (Post-traumatic stress disorder checklist for DSM-5 (PCL-5)). Results In our study, 81 healthcare workers completed the survey. Of the total responding participants 67.9% were females. We noticed that the example was young (58%), also 59.3% had

Introduction The legally incapacitated major is any person who, having acquired the legal majority, should therefore enjoy his rights, and face his social duties, but because of an alteration of his physical or mental faculties, is not able to provide alone for the safeguarding of his interests, nor to face alone his social obligations; there is, therefore, a need for protection which is the placing under guardianship. Objectives To describe the clinical and sociodemographic profile of the subjects put under guardianship in the psychiatric services of Monastir. Methods This is a retrospective descriptive study that focused on 71 files of subjects examined in the context of psychiatric expertise of guardianship in the psychiatric department Fattouma Bourguiba of Monastir during the period from 10-02-2016 to 08-06-2022. Results In total, we included 71 files of the subjects who were examined in the framework of the expert assessments of guardianship. The average age was 53 years. The predominance of males was noted with a sex ratio M/F = 1.5. Most of the patients were of urban origin; more than half (54.9%) were single with an average socioeconomic level for most of the patients (81.7%); 53.5% were illiterate and only 11.3% had a higher education level. Among the somatic antecedents in our population, 40.9% had neurological pathologies: stroke 8.5%, epilepsy 7%, and dementia 9.9%. The psychiatric history (71.8%) was marked by intellectual disability (47.9%) followed by schizophrenia (28.2%). Neuropsychiatric comorbidity was noted in 25.4%. The diagnoses retained at the time of the expertise were: intellectual disability (47%), followed by psychosis and dementia with similar percentages of 21%. The duration of the evolution of the symptoms in our population varied between 1 year and 60 years with an average of 22.56 years. The request for guardianship was made by the siblings in 40.8% of cases, followed by the ascendants in 21.1%. All the assessments took place at the hospital on a pre-arranged appointment and were formulated in French language. Conclusions The knowledge of the specificities of the different Tunisian laws governing guardianship is essential and the meticulous drafting of expert reports requires adapted training, which should be included in the basic training modules for psychiatrists. Disclosure of Interest None Declared

Introduction The number of suicidal patients who are consulting hospitals is increasing. Therefore nurses are more frequently faced to dealing with these patients. Empathy plays an essential role in the nurse-patient relationship and influences therapeutic effectiveness. Objectives Assess the impact of empathy level and investigate its factors on psychiatric and emergency department nurses’ attitudes toward a suicidal patient. Methods This is a cross-sectional analytical study that focused on nurses working in emergency and psychiatric departments in two Tunisian Hospitals. It was conducted between February and April 2022. We used the Cognitive and Affective Empathy questionnaire (QCAE) to evaluate the empathy level. Results Our study involved 60 nurses with an average age of 35,23 and a sex ratio of 0.76. Forty-seven percent of the nurses feel pity for the suicidal person while 16.7% remain indifferent. Fifty-seven percent of respondents believe that attempting suicide is primarily a sign of weakness and 45% believe that its a sign of suffering. While dealing with a suicidal patient, 45% of caregivers choose to reassure family and friends while 6.7% prefer to call the police to investigate. Among the nurses, 58.4% had an affective empathy score greater than or equal to 30 while 51.9% of them had a cognitive empathy score greater than or equal to 40. There was no statistically significant association (p>0.05) between the QCAE score and: age, gender, marital status, number of years in current service, number of children, and personal psychiatric history. There is a significant association between The department and both emotional Contagion and Perspective taking ( p

Background: Atrial fibrillation (AF) is an important health problem in Tunisia. A significant change in the epidemiological pattern of heart disease has been seen in the last 3 decades; however, no large prospective multicenter trial reflecting national data has been published so far. Robust data on the contemporary epidemiological profile and management of AF patients in Tunisia are limited., Objective: The aim of this study is to analyze, follow, and evaluate patients with AF in a large multicenter nationwide trial., Methods: A total of 1800 consecutive patients with AF by electrocardiogram, reflecting all populations of all geographical regions of Tunisia, will be included in the study, with the objective of describing the epidemiological pattern of AF. Patients will be officially enrolled in the National Tunisian Registry of Atrial Fibrillation (NATURE-AF) only if an electrocardiogram diagnosis (12-lead, 24-hour Holter, or other electrocardiographic documentation) confirming AF is made. The qualifying episode of AF should have occurred within the last year, and patients do not need to be in AF at the time of enrollment. Patients will be followed for 1 year. Incidence of stroke or transient ischemic attack, thromboembolic events, and cardiovascular death will be recorded as the primary end point, and hemorrhagic accidents, measurement of international normalized ratio, and time in therapeutic range will be recorded as secondary end points., Results: Results will be available at the end of the study; the demographic profile and general risk profile of Tunisian AF patients, frequency of anticoagulation, frequency of effective treatment, and risks of thromboembolism and bleeding will be evaluated according to the current guidelines. Major adverse events will be determined. NATURE-AF will be the largest registry for North African AF patients., Conclusions: This study would add data and provide a valuable opportunity for real-world clinical epidemiology in North African AF patients with insights into the uptake of contemporary AF management in this developing region., Trial Registration: ClinicalTrials.gov NCT03085576; https://clinicaltrials.gov/ct2/show/NCT03085576 (Archived by WebCite at http://www.webcitation.org/6zN2DN2QX)., Registered Report Identifier: RR1-10.2196/8523., (©Afef Ben Halima, Sana Ouali, Mohamed Sami Mourali, Sonia Chabrak, Rafik Chettaoui, Manel Ben Halima, Abdeddayem Haggui, Noureddine Larbi, Salma Krichène, Sonia Marrakchi, Slim Kacem, Rim Chrigui, Mohamed Fahmi Abbes, Hédi Baccar, Nadia Baraket, Najeh Ben Halima, Ali Ben Khalfallah, Mohamed Ben Mbarek, Soraya Ben Youssef, Essia Boughzala, Mohamed Rachid Boujnah, Habiba Drissa, Habib Gamra, Ali Gasmi, Habib Haouala, Youssef Harrath, Ines Issa, Gouider Jeridi, Salem Kachboura, Samir Kammoun, Sondes Kraiem, Faouzi Maatouk, Sami Milouchi, Wided Nasraoui, Ali Neji, Khaled Sayahi, Wissem Sdiri, Wajih Smati, Samir Tlili, Leila Abid, Salem Abdesselem, Lilia Zakhama, Abdallah Mahdhaoui, Helmi Kammoun, Skander Ben Omrane, Faouzi Addad. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 15.10.2018.)

Background & Aims: Currently approved antivirals rarely cure hepatitis B virus (HBV) infection. Therefore additional therapeutic strategies interfering with other viral replication steps are needed. Using synthetic lipopeptides derived from the HBV envelope protein, we previously demonstrated prevention of de novo HBV infection in vivo. We aimed at investigating the ability of the lipopeptide Myrcludex-B to block HBV spreading post-infection., Methods: uPA/SCID mice reconstituted with human hepatocytes were infected with HBV. Daily subcutaneous Myrcludex-B administration was initiated either 3 days, 3 weeks or 8 weeks post HBV inoculation. Viral loads were quantitated in serum and liver, and visualized by immunohistochemistry., Results: Myrcludex-B efficiently prevented viral spreading from the initially infected human hepatocytes, as demonstrated by the lack of increase in viremia, antigen levels and amount of HBcAg-positive human hepatocytes determined 6 weeks after treatment. Myrcludex-B efficiently blocked HBV dissemination also when treatment was started in the ramp-up phase of infection, in mice displaying moderate levels of circulating virions (median 3 × 10(6)HBV DNA copies/ml). Notably, after 6 weeks of treatment, not only the amount of HBcAg-positive hepatocytes, but also intrahepatic cccDNA loads, remained comparable to values found in mice sacrificed 3 weeks post-infection. In none of the experimental settings, drug administration affected human hepatocyte half-life or altered virion productivity., Conclusions: Myrcludex-B efficiently not only prevented HBV spreading from infected human hepatocytes in vivo, but also hindered amplification of the cccDNA pool in initially infected hepatocytes. Administration of an entry inhibitor, possibly used in combination with current HBV drugs, may improve patients' treatment outcome., (Copyright © 2012 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)