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Purpose This study aims to assess the awareness about the rights of people with mental illness in the main psychiatric hospital in Tunisia among the service users, the family members and the staff. Design/methodology/approach The Convention of Rights of People with Disabilities mandates that State Parties initiate and maintain campaigns and human rights training to promote understanding of the rights of people with mental illnesses, considered as a main factor for their fulfillment. Service users, family members and staff evaluated, through a survey, the importance of ten rights for persons with mental illness, stated in the convention. Findings Disparities were found in the perception of the different rights by and between the three groups. The highest levels of awareness were associated with the freedom from torture or degrading treatment and the right to live with dignity and respect, whereas the lower importance were assigned to the right to participation in recovery plans, to give consent and to exercise legal capacity. Originality/value The lack of awareness and the poor perception of rights of people with mental illness is one of the barriers to their achievement. More training and awareness raising is necessary.

Resume Introduction Le travail poste peut etre a l’origine de problemes de sante et de troubles du sommeil et ainsi retentir sur la sante mentale et evoluer vers un cercle vicieux. Les objectifs de notre travail etaient d’evaluer la frequence des troubles du sommeil et des troubles psycho-affectifs chez le personnel paramedical ayant un travail poste et de depister un syndrome d’apnees-hypopnees obstructives du sommeil (SAHOS) chez eux. Methodes Etude transversale realisee aupres du personnel paramedical du CHU Mongi Slim La Marsa a Tunis. Trois questionnaires traduits en arabe (questionnaire de Berlin, questionnaire de Spiegel et echelle d’anxiete et de depression des hopitaux [HAD]) ont ete poses par le meme investigateur durant l’enquete. Resultats Cent cinquante-huit personnels paramedicaux ont ete interroges dont 46,2 % etaient des infirmiers, 23,4 % des ouvriers et 19 % des techniciens superieurs. L’anciennete professionnelle moyenne dans le travail poste etait de 10,27 ans. L’âge moyen etait de 36,48 ans avec predominance feminine a 70,9 %. Des troubles du sommeil ont ete detectes dans 40,5 % des cas, un SAHOS dans 24 %, une anxiete dans 53,2 % et une depression dans 17,1 %. Conclusion Les troubles du sommeil et psycho-affectifs sont frequents chez le personnel paramedical hospitalier ayant un travail poste en hospitalier. Des consultations de depistage en medecine du travail s’averent necessaires afin de detecter precocement ces troubles.

Zinc (Zn) deficiency is a common condition and could contribute to poor outcomes in hemodialysis (HD) patients. The aim of this study was to evaluate the effects of Zn supplementation on serum copper (Cu) to Zn and C-reactive protein (CRP) to albumin ratios (CAR) in HD patients.Seventy-seven HD patients were enrolled in a multicentre simple-blind randomized clinical trial. Only 37 HD patients completed the study; they were randomly divided into two groups and supplemented with zinc sulphate (n=17) or placebo (n=20) for two months. Serum Zn and Cu were measured by atomic absorption spectrophotometry. Serum albumin and hypersensitive-CRP were assessed by colorimetric and immunoturbidimetric method, respectively. Determinations were performed before and after supplementation.After two months of supplementation, serum Zn significantly increased, and Cu to Zn ratio decreased in Zn supplemented group, but remained unchanged in the placebo group. In parallel, serum albumin concentrations significantly increased, and CAR decreased in Zn supplemented group only.Zn supplementation reduces Cu to Zn and CRP to albumin ratios in HD patients. These changes point towards an improvement in nutritional, oxidative and inflammatory status. The study findings suggest that correcting Zn deficiency reduces poor outcomes in HD patients.Manjak cinka (Zn) je uobičajeno stanje i može doprineti lošim ishodima kod pacijenata na hemodijalizi (HD). Cilj ove studije je bio da proceni efekte suplementacije Zn na odnos serumskog bakra (Cu) i Zn i odnos C-reaktivnog proteina (CRP) i albumina (CAR) kod pacijenata na hemodijalizi.Sedamdeset i sedam pacijenata na hemodijalizi je uključeno u jednostruko - slepo i randomizovano kliničko ispitivanje u više centara. Samo 37 pacijenata na hemodijalizi je završilo studiju. U nasumično podeljene dve grupe počelo se sa suplementacijom u ishrani cink sulfatom (n=17) ili placebom (n=20) tokom dva meseca. Serum Zn i Cu su mereni atomskom apsorpcionom spektrofotometrijom. Albuminski serum i hipersenzitivni CRP procenjeni su kolorimetrijskim i imunoturbidimetrijskim metodom, svaki posebno. Merenja su vršena i pre i posle suplementacije.Nakon dva meseca suplementacije Zn u serumu se značajno povećao, a odnos Cu i Zn smanjio u grupi gde je sprovođena suplemenacija Zn, ali je ostao nepromenjen u grupi sa placebom. Paralelno sa tim, koncentracije albumina u serumu značajno su porasle, a CAR se smanjio samo u grupi sa suplementacijom Zn.Suplementacija Zn smanjuje odnos Cu u odnosu na Zn, i CRP u odnosu na albumin kod pacijenata na hemodijalizi. Ove promene ukazuju na poboljšanje statusa u vezi sa ishranom, oksidacijom i zapaljenjima. Nalazi studije sugerišu da smanjenje deficita Zn umanjuje šanse za loše ishode kod pacijenata na hemodijalizi.

The involvement of immunity in the pathogenesis of schizophrenia and related psychoses was suspected a century ago but was shadowed by the dopaminergic hypothesis after the discovery of antipsychotics. We currently know that this latter theory has many limits and cannot account for the wide variety of psychotic conditions. The immune-inflammatory theory is now one of the most promising axes of research in terms of pathogenesis of several mental health conditions. Immunity and inflammation play a role at least in a subgroup of patients with psychosis. The immune system is complex with a variety of components and mediators that can all have effects on the brain and thus mediate psychiatric symptoms. In this chapter we will explore the scientific evidence of the role of immune system in pathophysiology of psychosis. The sections of this chapter will discuss the role of innate system components (cytokines, microglia, inflammation.), the role of adaptive system (lymphocytes and antibodies) with a section focusing on auto-immunity and particularly antineuronal antibodies. Finally we will discuss how this research can impact patients management and elaborate recommendations for future research.

Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is the rescue treatment proposed to patients with refractory cardiogenic shock. The VA-ECMO implantation promotes inflammation and ischemia-reperfusion injuries through the VA-ECMO flow, causing digestive mucosa barrier disrupture and inducing translocation of bacterial wall components—Lipopolysaccharides (LPS) with further inflammation and circulatory impairment. LPS is a well-studied surrogate indicator of bacterial translocation. Oxiris membrane is a promising and well-tolerated device that can specifically remove LPS. The main study aim is to compare the LPS elimination capacity of Oxiris membrane vs. a non-absorbant classical renal replacement (RRT) membrane in patients with cardiogenic shock requiring VA-ECMO.Methods: ECMORIX is a randomized, prospective, single-center, single-blind, parallel-group, controlled study. It compares the treatment with Oxiris membrane vs. the standard continuous renal replacement therapy care in patients with cardiogenic shock support by peripheral VA-ECMO. Forty patients will be enrolled in both treatment groups. The primary endpoint is the value of LPS serum levels after 24 h of treatment. LPS serum levels will be monitored during the first 72 h of treatment, as clinical and cardiac ultrasound parameters, biological markers of inflammation and 30-day mortality.Discussion: Oxiris membrane appears to be beneficial in controlling the VA-ECMO-induced ischemia-reperfusion inflammation by LPS removal. ECMORIX results will be of major importance in the management of severe cases requiring VA-ECMO and will bring pathophysiological insights about the LPS role in this context.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT04886180.

The present study aimed to evaluate the hypoglycemic and hypolipidemic activities of Aloe vera mucilage in alloxaninduced diabetic rats. Adult male Wistar rats were assigned into 4 groups (6 rats/group), as follows: the first group (C) served as the controls. The second group of rats (AL) received a single subcutaneous dose of alloxan at 120 mg kg-1bw. These groups received 1 mL of NaCl 9%. The third group (AL+Av) represented diabetic rats treated with 1 mL of mucilage extracted from Aloe vera leaves. The fourth group (C+Av) corresponded to control rats administered with 1 mL of Aloe vera mucilage. NaCl or Aloe vera mucilage were intraperitoneally injected to the rats. Diabetic rats exhibited significant hyperglycemia accompanied by glycosuria. We also observed a significant reduction in the liver weight and glycogen content of the specimen. A reduced level of serum insulin was also observed among diabetic rats. However, the levels of serum triglycerides and total cholesterol increased in alloxaninduced diabetic rats. Aloe vera mucilage administration to diabetic rats partially and totally corrected glycaemia and liver glycogen content and serum insulin level, respectively. The rats’ lipid status has also been improved. Medicinal plants, including Aloe vera, are expected to correct hyperglycemia and hyperlipidemia in diabetic patients to prevent the adverse effects of synthetic drugs.

Highlights • Ballistic tramatology in the upper humerus extremity region presents challenging management difficulties. • Resurfacing shoulder hemi arthroplasty in ballistic injuries is not commonly reported. • The indication of resurfacing shoulder hemi arthroplasty was appropriate regarding good functional outcome., Introduction Ballistic traumatology of the shoulder joint is uncommon. Usually, it is associated to comminuted fractures of the upper humerus. Total shoulder arthroplasty has been proposed to restore a good function. The indication of resurfacing hemi arthroplasty still controversial and is not commonly reported after ballistic traumatology. Presentation of case We report the case of a 26-year-old soldier victim of a gunshot of the left shoulder entailing a comminuted complex fracture of the upper extremity of the humerus. After shoulder immobilization of 3 months joint mobility was very limited. Radiographs showed bone malunion with a total loss of the hemispherical form of the humeral head. Patient has undergone a resurfacing hemi arthroplasty. Surgery outcome was good. At five years of follow-up, there were no major functional complaints. Clinical and radiological result was satisfactory with a good shoulder mobility. Discussion Shoulder arthroplasty provided good functional outcome in case of post fracture sequelae. Difficulty was to choose between total arthroplasty and hemi arthroplasty. In young and active patients, authors disapproved total arthroplasty in post traumatic gleno-humeral arthrosis to prevent revision difficulties especially after glenoid erosion. Conclusion Although follow-up still be limited, the indication of shoulder hemi arthroplasty was appropriate regarding functional outcome and patient satisfaction. Further clinical and radiological supervision still necessary to detect glenoid erosion.

THE AIM: to determine the relationship between non-traditional risk factors and calcification of the aortic valve in patients with CKD C5D.PATIENTS AND METHODS. We examined 103 patients receiving treatment with program hemodialysis (53 men and 50 women, mean age 54.8 ± 15.2 years). A traditional nephrological examination was carried out, including the determination of synchronous 24-hour ECG and AD monitoring, an echocardiographic study evaluating the thickness of the carotid arteries intima-media complex. In 79 patients, the status of vitamin D was determined by the enzyme immunoassay.RESULTS.Traditional (age over 50, male and dyslipidemic) and non- traditional (duration of hemodialysis more than 5 years, calcitriol level less than 10 pmol/L) risk factors for the calcification of the aortic valve were revealed. The average concentration of calcifediol in serum was 33.3 ± 13.8 nmol /L, calcitriol – 11.5 ± 6.9 pmol /L. Calcification of the aortic valve was detected in 48 patients, 2 times more often in men. Stenosis of the aortic valve was found in 28% of men and 22% of women. During the first five years of HD, the prevalence of aortic valve calcification increased 1,5 times and continued to increase later, however, not to the degree of stenosis. The risk of stenosis increased by age over 50 years (3,6 times), whereas the use of alfacalcidol was accompanied by a 70% decrease of stenosis risk. Deficiency of calcitriol (but not calcifediol) increased the risk of calcification (but not stenosis) of the aortic valve in 2 times.CONCLUSION.Vitamin D deficiency is associated with an increased risk of developing extraosteal calcification, including aortic valve. A decrease in the concentration of calcitriol in the blood serum is a predictor for a specific lesion of the aortic valve. Adequate correction of phosphoric calcium exchange can serve as one of the methods for its prevention.

Purpose To examine the IL-8 expression levels and association of genetic variants with the risk of childhood persistent asthma prognosis. Methods Overall, 170 asthmatic children and 170 healthy controls were included in this case–control study. The human IL-8 serum levels were measured using ELISA. The IL-8 mRNA expression levels were assessed by a real-time quantitative reverse transcription-polymerase chain reaction (qRT-PCR). The genotyping was performed by polymerase chain reaction–restriction fragment length polymorphism (PCR–RFLP) methods. Results The IL-8 expression at both protein and mRNA levels was found to be significantly elevated in asthmatic children compared to healthy subjects (P

Introduction: The medical curriculum is responsible for sleep disorders among students as well as the trainees in medicine. The aim of this study was to screen sleep disorders among medical trainees including interns (in training for family medicine) and residents (in training for different specialties). Method: This is a cross-sectional study based on an online questionnaire published on the website of the Faculty of Medicine of Tunis with anonymous answers. This questionnaire was composed of Spiegel Sleep Questionnaire (score/30) and HAD Scale (score/21 for both anxiety and depression). Sleep disorders were diagnosed if Spiegel score was 7 respectively for each pathology. HAD scale only detects psycho-emotional disorders which must be confirmed by a psychiatrist. Results: Two hundred and thirty-seven medical trainees answered the questionnaire(94 interns, 143 residents). The sex-ratio was F/M=2.24 and mean age=27.4 years. Smoking was found in 15.2% of cases. The mean Spiegel score was 18.28 (16% had sleep disorders). The mean anxiety score was 10.48 (81% had anxious troubles). The mean depression score was 9 (65% had depressive troubles). There was no significant difference between results in interns and residents groups (19% of interns vs 14% of residents for sleep disorders; 80% of interns vs 81% of residents for anxiety; 65% of interns vs 64% of residents for depression). A high score of anxiety and depression was correlated to a low Spiegel score (p Conclusion: Medical trainees often face a huge workload with tiring guards and insufficient rest, which would explain the alarming results of this study.

Single nucleotide polymorphism (SNPs) in genes coding for chemokines may be associated with some cancer. The purpose of this study was to investigate the impact of CCR2-64I and CXCL12-3′A SNPs on the susceptibility and the clinicopathological characteristics of NSCLC (Non-Small Cell Lung Cancer) in the Tunisian population. 170 NSCLC patients and 225 healthy controls screened by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis were enrolled. A significant association for the homozygous genotype CCR2 64I/64I with lung cancer risk was observed ( P = 0.004). An increased significant frequency of the -64I allele ( P = 0.0006) was noted in the patient’s group. Clinical analysis indicated a positive association of the -64I allele among squamous cell lung carcinoma patients ( P = 0.003). The CCR2 mRNA extracted from peripheral blood mononuclear cells (PBMC) was found highly expressed in NSCLC patients compared to controls. The same higher levels were found in patients carrying the CCR2 64I/64I genotype. No significant association was retrieved with CXCL12-3′A polymorphism. In conclusion, our results revealed that the subjects with -64I allele of CCR2-64I gene polymorphism, expressed a significantly higher risk for NSCLC risk without influence on its pathological progression.

Summary Introduction Sexuality in patients with schizophrenia is often overlooked. Very few studies examined sexual dysfunctions in such patients, especially in Tunisian socio-cultural context. The objective of this work was to assess sexual dysfunctions in Tunisian patients with schizophrenia. Methods A survey was conducted between August 8 and September 5, 2011 among consultants at departments of psychiatry “E” and “F” in Razi Mental Health Hospital in Mannouba, Tunisia. All consultants with schizophrenia, aged between 18 and 60, who were sexually active during the period of the study, were included. Sexual dysfunctions were assessed using the Changes in Sexual Functioning Questionnaire (CSFQ) translated to Arabic dialect. Results Thirty-eight patients were included. Sexual dysfunctions prevalence was 71% (n = 27) with no difference by sex. These figures are higher than those of the general population and are consistent with previous studies using the CSFQ. The average number of sexual dysfunctions was 3.8 per patient. There was no between-gender difference. The most frequent dysfunction was sexual pleasure dysfunction (50%; n = 19). The presence of sexual dysfunctions was significantly associated with early onset of schizophrenia, with high scores on the PANSS, with long acting antipsychotics, with high doses of antipsychotics, with the number of prescribed psychotropic medications and with good insight. Conclusions This study contributes to a better understanding of sexuality in patients with schizophrenia. Clinicians should consider sexual dysfunctions in these patients and discuss with them potential solutions to improve their quality of life and adherence to therapy.

Interleukin-17 (IL-17) is a proinflammatory cytokines produced by T helper 17 (Th17) cells, which plays an important role in both innate and adaptive immune systems. Genetic variants in the IL-17 genes may influence the immunopathogenesis of many cancers. In our study, we investigated the association of three single-nucleotide polymorphisms (SNPs: -152 G/A, 7488 A/G and 7383 A/G) in the IL-17A and IL-17F genes with lung cancer risk, in the Tunisian population. The genotypic and allelic distributions of IL-17A and IL-17F genes polymorphisms were analyzed by Polymerase Chain-Reaction (PCR) and Restriction Fragment Length Polymorphism (RFLP) for 239 patients and 258 healthy controls. Our results revealed a statistically significant association between IL-17F 7488G allele and increased lung cancer risk (P=0.028). Stratification analysis indicated that IL-17F 7488G allele enhances the risk of lung cancer development among men and oldest age subject groups (P0.05). Patients with IL-17F 7488G allele were also more likely to be diagnosed at advanced stage (P=0.04), or with metastatic lung cancer (P=0.035). Furthermore, no significant association between IL-17F 7383 A/G, IL-17 -152G/A polymorphisms and lung cancer risk was observed (P0.05). However, we reported contradictory findings on the association of IL-17 -152 G/A polymorphisms with lung cancer risk. In addition, we suggested the existence of a biological interaction between IL-17A, but not IL-17F polymorphisms and smoking. Our findings suggest that IL-17F 7488G allele is associated with increased lung cancer risk in the Tunisian population.

Interleukin 8 (IL-8), is a proinflammatory chemokine, has been reported to have angiogenic activity and to be responsible for tumor-associated angiogenesis in several cancers. In this study, we aimed to study the (IL-8) gene polymorphism in relation with risk development of non small cell lung cancer in Tunisian patient. Two single nucleotide polymorphisms (-251T/A [rs4073], +781C/T [rs2227306]) of the IL-8 gene were screened in 170 patients with NSCLC and 225 healthy controls by PCR-RFLP. Significant association for the IL-8 -251T/T genotypes (P=0.004) and an increased significant frequency of IL-8 -251T allele were noted in the patient's group (P=0.0007). Clinical analysis indicated a borderline positive association of IL-8 -251T allele among adenocarcinoma patients (P=0.003). Our study indicated that IL-8 -251T allele was highly associated with large tumor size and high grade stage of NSCLC. Moreover, a significantly increased risk of NSCLC was associated with IL-8 +781C allele in patients with large tumor size (T3 and T4) (P=0.004). IL-8 mRNA expression was found highly expressed in NSCLC patients compared to healthy controls. The same higher level was even found in patients carrying IL-8 -251T/T genotype. Our results indicated that the IL-8 promoter polymorphism is associated with NSCLC risk.

IntroductionViolence against elderly persons is an intricate social, legal and ethic issue. Alzheimer's patients are the most vulnerable individuals to mistreatment and neglect. The aggressor can be even the main helper of the patient. We noticed a wide underestimation of this phenomenon, which remains taboo subject in our society.Objectives and methods– The aim of our study is to identify predictive factors of mistreatment of Alzheimer's patients through a prospective and descriptive study, within patients following in the department of neurology in Razi's hospital.– we evaluate cognitive function (MMSE) and the importance of behavioural disorders.– we explored helper's socio-demographic characteristics and the quality of aid relationship.– anger and hostility within relationship were estimated through family attitude scale.ResultsOur sample accounts 60 informal caregivers predominately female (91.7%) with an average age of 49.67 years, mostly are married (71.66%) and jobless (38.88%):– in 78.3% of cases, caregivers spent about 12 to 24 hours per day with Alzheimer's patient.– the average score of FAS was about 52.4% with an important emotional charge (score >60).– twenty-five caregivers wished the death of the patient and 42 others admitted being sarcastic with him.– We noticed a correlation between mistreatment and both cognitive function and behavioural disorders.ConclusionOur results support the fact that mistreatment of people with dementia is closely related with the exhausting situation of the main caregiver.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionThe Alzheimer's patient assistance relationship is a morally painful experience, most frequently discussed in terms of “burden” in the literature, especially as professionals and institutional intermediaries are underdeveloped in Tunisia.GoalIt is intended to assess the level of burden among caregivers of patients with Alzheimer's disease and to search factors associated with a high level of burden.MethodologyThis is a retrospective descriptive study. Patients were recruited from neurology department of Razi hospital, which were hospitalised between the months of December 2012 and March 2013. The burden was measured using the Zarit inventory.Results and discussionThirty patients were included. The majority female, most caregivers are descendants (60%), then, daughters in law (33%), and finally the spouses (23%). 80% of caregivers lived in the same home as patients. Caregivers were asked about all the items of the grid Zarit. The average burden in our sample is 59.9 + 16 3. We observed that 33% have absent to light burden (score 60), according to the classification proposed by Zarit. Sex, kinship and cohabitation with the patient were not associated with a higher burden.ConclusionThe study of factors correlated with high levels of burden aims at finding ways of intervention and support to fight against the isolation of caregivers and the occurrence of anxiodepressive complications.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Groundwater quality monitoring is one of the most important aspects in groundwater studies in arid environments particularly in developing countries, like Saudi Arabia, due to the fast population growth and the expansion of irrigated agriculture and industrial uses. Groundwater samples have been collected from eight lo- cations in Al-Ula in Saudi Arabia during June 2012 and January 2013 in order to investigate the hydrochemical characteristics and the groundwater quality and to under- stand the sources of dissolved ions. Physicochemical pa- rameters of groundwater such as electrical conductivity, pH, total dissolved solid, and major cations and anions were determined. Chloride was found to be the dominant anion followed by HCO � 3 and SO4 2� . Groundwater of the study area is characterized by the dominance of alkaline earths (Ca 2+ +M g 2+ )o ver alkali metals (Na + +K + ). The analytical results show that the groundwater is generally moderately hard and slightly alkaline in nature. The binary relationships of the major ions reveal that water quality of the Al-Ula region is mainly controlled by rock weathering, evaporation, and ion exchange reactions. Piper diagram was constructed to identify hydrochemical facies, and it was found that majority of the samples belong to Ca-Cl and mixed Ca-Mg-Cl facies. Chemical indices like chloro- alkali indices, sodium adsorption ratio, percentage of sodi- um, residual sodium carbonate, and permeability index were calculated. Also, the results show that the chemical composition of groundwater sources of Al-Ula is strongly influenced by lithology of country rocks rather than an- thropogenic activities.

Many studies reported that Vitamin D Receptor (VDR) gene polymorphisms might influence the cancer risk due to their antiproliferative, antiangiogenic, and apoptotic effects. The aim of this study was to explore the genetic association of VDR polymorphisms with lung cancer risk in Tunisian population. The genotype and haplotype frequencies of four VDR polymorphisms, FokI (rs2228570), BsmI (rs1544410), ApaI (rs7975232) and TaqI (rs731236) were studied using polymerase chain reaction and restriction fragment length polymorphism analysis in 240 patients with lung cancer and 280 healthy controls. The distribution of genotype frequencies differed significantly between lung cancer subjects and controls (FokI P adj = 0.002; ApaI P adj = 0.013). Haplotype analyses revealed a significant association between G-A-C and A-C-T haplotypes and lung cancer risk (P corr = 0.0128, P corr = 0.008). When patients were stratified according to gender, age, and smoking, significant associations were detected with FokI and TaqI polymorphisms. We found a lack of association between BsmI, TaqI polymorphisms and lung cancer risk (P > 0.05). Only, the attributable proportion due to interaction and the synergic index for interaction between ApaI polymorphism and smoking were statistically significant (P adj = 0.74, 95 % CI = 0.38-1.20) and (P adj = 0.63, 95 % CI = 0.05-1.21), respectively. Both the additive interaction measures suggested the existence of a biological interaction between SNP ApaI, but not FokI, and smoking. The multiplicative interaction measure was not statistically significant (P > 0.05). This is the first study in Tunisia, which suggested that VDR FokI and ApaI polymorphisms might be risk factors for lung cancer development.

BACKGROUND Lung cancer (LC) is one of the most lethal malignant disorders; it is generally divided into two groups: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). In our present study we have been interested to NSCLC. Several approaches were adopted to study the etiology or pathophysiology of this disease. As recent reports have focused on the genetic susceptibility to this disease, with many candidate genes studied, we chose TNF in view of the major role it plays in the immune pro inflammatory system and its association with increased risk of a variety of human cancers. We have investigated three polymorphisms in the promoter region of the TNFalpha gene (-308 G/A and -238 G/A) and TNFbeta + 252A > G for their susceptibility to non-small cell lung cancer (NSCLC) in Tunisian population. METHODS We compared the distribution of these polymorphisms between 133 NSCLC patients and 174 healthy controls using a polymerase chain reaction restriction fragment length-polymorphism (PCR-RFLP) analysis. The frequencies of the two TNFalpha (-238 and -308) "A" alleles were significantly higher in NSCLC patients than in healthy controls respectively (p = 0.01; OR = 1.92; 95% CI 1.14 - 3.23 and p = 0.0000008; OR = 3.65; 95% CI 2.12 - 6.30), whereas the frequency of the TNFbeta + 252 G allele was approximately similar in the two compared groups. RESULTS This study supports a relationship between TNFalpha -238G/A and TNFalpha -308G/A polymorphisms and the susceptibility to lung cancer. Contrary to other studies, the -308 A and -238A alleles have an inductive action on lung cancer development and progression in our Tunisian population. CONCLUSIONS This study indicates that the TNFalpha -308G > A and TNFalpha -238G > A would be associated with increased susceptibility to lung cancer but no significant association was found in TNFbeta + 252A > G polymorphism.

International audience; Leaching experiments of solid matrices (bitumen and cement pastes) have been first implemented to define the physicochemical conditions that microorganisms are likely to meet at the bitumen-concrete interface (see the paper of Bertron et al.). Of course, as might be suspected, the cement matrix imposes highly alkaline pH conditions (10 < pH < 11). The screening of a range of anaerobic denitrifying bacterial strains led us to select Halomonas desiderata as a model bacterium capable of catalyzing the reaction of nitrate reduction in these extreme conditions of pH. The denitrifying activity of Halomonas desiderata was quantified in batch bioreactor in the presence of solid matrices and / or leachate from bitumen and cement matrices. Denitrification was relatively fast in the presence of cement matrix (< 100 hours) and 2 to 3 times slower in the presence of bituminous matrix. Overall, the presence of solid cement promoted the kinetics of denitrification. The observation of solid surfaces at the end of the experiment revealed the presence of a biofilm of Halomonas desiderata on the cement paste surface. These attached bacteria showed a denitrifying activity comparable to planktonic bacterial culture. On the other side, no colonization of bitumen could be highlighted as either by SEM or epifluorescence microscopy. Now, we are currently developing a continuous experimental bioreactor which should allow us a more rational understanding of the bitumen-cement-microbe interactions.

One hundred and three psychiatric inpatients (74 men) were assessed for a wide spectrum of autoantibodies including antinuclear, antismooth muscle, antimitochondrial, antiDNA, anti-phospholipid, anti-cardiolipin IgG and IgM, antikeratin, rheumatoid factor, antithyroperoxydase, antigliadin IgA and IgG, antitransgutaminase, and antiendomysium antibodies. Four groups of patients were considered separately, including 47 with schizophrenia, 23 with schizoaffective disorder, 16 with bipolar disorder and 17 patients with other different psychiatric diagnosis. Forty one healthy, age- and sex-matched blood donors were used as a control group. There were no significant difference in the prevalence of the different autoantibodies between patients (N = 103) and controls except for antigliadin IgG (30.1 vs 9.8 respectively, p = 0.01). Presence of autoantibodies was influenced by age but not by sex or treatment. As for diagnosis categories, patients with bipolar disorder presented significantly more autoantibodies than the three other categories and controls. These results point out a possible autoimmune activation in at least a subgroup of psychiatric patients especially amongst those suffering from bipolar disorder.

Chromium(VI), a very strong oxidant, causes high cytotoxicity through oxidative stress in tissue systems. Our study investigated the potential ability of ethanolic Citrus aurantium L., family Rutaceae extract, used as a nutritional supplement, to alleviate lung oxidative damage induced by Cr(VI). A high-performance liquid chromatography coupled with a mass spectrometer method was developed to separate and identify flavonoids in C. aurantium L. Six flavonoids were identified, as (1) poncirin, (2) naringin, (3) naringenin, (4) quercetin, (5) isosinensetin, and (6) tetramethyl-o-isoscutellarein. Adult Wistar rats, used in this study, were divided into six groups of six animals each: group I served as controls which received standard diet, group II received via drinking water K2Cr2O7 alone (700 ppm), groups III and IV were pretreated for 10 days with ethanol extract of C. aurantium L. at doses of 100 and 300 mg/kg body weight/day, respectively, and then K2Cr2O7 was administrated during 3 weeks, and groups V and VI received during 10 days only C. aurantium L. ethanol extract at doses of 100 and 300 mg/kg/day, respectively. Ethanol extract of C. aurantium L. was administered orally. Rats exposed to Cr(VI) showed in lung an increase in malondialdehyde and protein carbonyl levels and a decrease in sulflydryl content, glutathione, nonprotein thiol, and vitamins C and E levels. Decreases in enzyme activities such as in Na(+)K(+) ATPase, catalase, glutathione peroxidase, and superoxide dismutase were noted. Pretreatment with C. aurantium L. of chromium-treated rats ameliorated all biochemical parameters. Lung histological studies confirmed the biochemical parameters and the beneficial role of C. aurantium L.

International audience; Patients with temporal lobe epilepsy (TLE), the most common form of epilepsy in adults, often display cognitive deficits. The time course and underlying mechanisms of cognitive decline remain unknown during epileptogenesis (the process leading to epilepsy). Using the rat pilocarpine model of TLE, we performed a longitudinal study to assess spatial and nonspatial cognitive performance during epileptogenesis. In parallel, we monitored interictal-like activity (ILA) in the hippocampal CA1 region, as well as theta oscillations, a brain rhythm central to numerous cognitive processes. Here, we report that spatial memory was altered soon after pilocarpine-induced status epilepticus, i.e., already during the seizure-free, latent period. Spatial deficits correlated with a decrease in the power of theta oscillations but not with the frequency of ILA. Spatial deficits persisted when animals had spontaneous seizures (chronic stage) without further modification. In contrast, nonspatial memory performances remained unaffected throughout. We conclude that the reorganization of hippocampal circuitry that immediately follows the initial insult can affect theta oscillation mechanisms, in turn, resulting in deficits in hippocampus-dependent memory tasks. These deficits may be dissociated from the process that leads to epilepsy itself but could instead constitute, as ILA, early markers in at-risk patients and/or provide beneficial therapeutic targets.

The existence of association between hyperhomocysteinaemia (HHC) and schizophrenia has been suggested by several recent studies. This study aimed to determine the prevalence of HHC and its main determinants, and sought a correlation with clinical features in Tunisian patients with schizophrenia. Plasma homocysteine (Hcy), folate, and vitamin B12, as well as the C677T methylene tetrahydrofolate reductase (MTHFR) polymorphism, were studied in 33 patients with schizophrenia, all free from antipsychotic treatment, and 35 age- and smoking-habit-matched healthy subjects as controls. Biochemical determinations and psychometric evaluations were carried out in patients before the administration of antipsychotics. The prevalence of HHC was higher and plasma B12 vitamin was significantly lower in patients. There was no significant difference in genotypic distribution and allelic frequency of the C677T MTHFR polymorphism between groups. Hcy was significantly correlated to the 'anhedonia-asociality' subscales of the Scale for the Assessment of Negative Symptoms (SANS). This study showed an association between HHC and schizophrenia, especially with the negative symptoms of the disease. In the Tunisian population, HHC in schizophrenia seems to be linked to vitamin B12 deficiency, likely caused by a lack of dietary animal proteins.

Introduction Stigma is a serious concern for people with bipolar disorder (PBD). It may have critical yet insidious repercussions on the course of the illness and may represent a barrier to recovery. Objectives To determine the influence of social stigma and internalized stigma on residual affective symptoms, treatment adherence, global functioning and metacognitive functioning in a population of euthymic PBD. Methods A Cross-sectional study was conducted on 32 outpatients with bipolar disorder I (BDI). Residual affective symptoms were evaluated using the Young Mania Rating Scale (YMRS) and the Hamilton Rating Scale for Depression (HRSD). Social stigma and internalized stigma were evaluated using the Discrimination and Stigma Scale (DISC). The Medication Adherence Rating Scale (MARS), the Global Assessment of Functioning (GAF) and the Metacognition Assessment Interview (MAI) were also used. Results Higher rates of social stigma were correlated with poorer global functioning (p=0.029) and poorer adherence to medication (p=0.022). However, higher social stigma correlated with better metacognitive capacities (p=0.0001, r=-0.61); good metacognition may lead to a better perception of social stigma. Self stigma was significantly correlated to residual depressive symptoms (p=0.0001) and to poorer global functioning (p=0.018) and poorer adherence to treatment (p=0.002). Better metacognitive capacities were also correlated with the ability to overcome stigma. Conclusions Social stigma and self stigma may have negative impact on several aspects of the BD that are essential to the outcome such as medical adherence, functioning and residual symptoms. Targeting stigma may help PBD achieve recovery.

The present study examined the effects of acute and chronic neurogenic stressors on the expression of two distinct angiotensin receptors in two stress-related brain nuclei: angiotensin type 1A receptor in the paraventricular nucleus of the hypothalamus and angiotensin type 2 receptor in the nucleus locus coeruleus. Male Wistar rats were divided into four experimental groups. The first two groups were subjected once to an acute 90-min immobilization or air-jet stress session, respectively. The other two groups were subjected to 10 days of daily 90-min immobilization sessions and, on the 11th day, one group was exposed to an additional 90-min immobilization and the other to a single air-jet stress (heterotypic but still neurogenic) session. In each group, rats were perfused before stress (0 min), immediately following stress (90 min) or 150, 180, 270 or 360 min (and 24 h in chronic immobilization) after the beginning of the last stress session. Basal expression of both angiotensin receptor subtype 1A and angiotensin receptor subtype 2 messenger RNA was minimal in non-stressed animals. Acute immobilization as well as air-jet stress induced similar patterns (time-course and maximal values) of angiotensin receptor subtype 1A messenger RNA expression in the paraventricular nucleus. Angiotensin receptor subtype 1A messenger RNA expression increased 90-150 min after the beginning of the stress and returned to basal levels by 360 min. Chronic stress immobilization slightly modified the pattern, but not maximal values of angiotensin receptor subtype 1A messenger RNA expression to further immobilization (homotypic) or air-jet stress (heterotypic). Acute immobilization and air-jet stress sessions induced similar locus coeruleus-specific angiotensin receptor subtype 2 messenger RNA expression. This expression increased 90 min following the onset of the stress session and remained elevated for at least 360 min. Chronic immobilization stress increased angiotensin receptor subtype 2 messenger RNA expression to levels comparable to those observed in acute stress conditions. Novel acute exposure to neurogenic stressors did not further increase these levels in either homotypic (immobilization) or in heterotypic (air-jet stress) conditions. These results suggest that central angiotensin receptors are targets of regulation in stress; therefore, stress may modulate angiotensin function in the paraventricular nucleus and locus coeruleus during chronic exposure to neurogenic stressors.

Introduction Recovery is an important concept in schizophrenia that has not been well defined or researched. It is crucial to determine its predictors. Aims To determine sociodemographic and clinical factors associated with remission and recovery in a population of patients with schizophrenia. Methods The design was an observational, cross-sectional and analytic study. We recruited all of the outpatients with schizophrenia or schizoaffective disorder (according to DSM IV-TR) who consulted psychiatry ward F from the 1/2//2013 to the 31/3/2013. Clinical and sociodemographic data for patients were gathered using an ad-hoc structured questionnaire. Clinical remission was defined according to criteria from the Remission in Schizophrenia Working Group (RSWG). Recovery was defined according to the following criteria from a Meta-Analysis by Jaaskelainen et al. (2013): a clinical remission (RSWG criteria) with a social remission (Global Assessment of Functioning score >=61) and no hospitalisation in the last two years. Results Our sample comprised 44 patient (65.9% were females and 34.1% were males). Remission was achieved in 36.4% of the cases and was correlated with paranoid schizophrenia (p=0.024) and schizoaffective disorder (0.02) diagnoses. Recovery was achieved in 15.9% of the cases and had higher rates in females (p=0.4). Conclusions Better remission rates in paranoid schizophrebia and schizoaffective disorder is a finding which is broadly consistent with numerous previous studies. In opposite, the fact that female patients are more likely to achieve recovery remains controversial.

Background & aims Dementia is one of the most common neuropsychiatric disorders in nursing home residents. Despite a high prevalence and a major impact on daily activities, dementia remains largely underdiagnosed and therefore rarely treated in nursing homes throughout the world. This study aims to determine the prevalence of dementia among residents of Manouba nursing home (in Tunis) and to identify the proportion of recognised cases of dementia among this population. Methods A cross-sectional study was performed from September to October 2012 among all consenting residents of Manouba nursing home. Sociodemographic data were collected by the means of a semi-structured questionnaire. Cognitive functions were assessed using the Montreal Cognitive Assessment (MoCA) test in its Arabic version. We excluded subjects who could not take the MoCA test because of a severe sensory deficit or a severe psychiatric condition. Results At the time of the study, the population of Manouba nursing home residents consisted of 116 subjects. After applying the exclusion criteria, we retained 77 subjects: 48 males (62.3%) and 29 females (37.7%). The average age was 72.6 years. The average MoCA score was 14.4 +/− 6.5 (range: 3 to 29). The prevalence of dementia in our population was 58.4% (n=45). Among these 45 subjects with dementia, only three (or 6.7% of dementia cases) were already diagnosed as such. Of these three patients, only one was on anticholinesterase treatment. Conclusion Dementia is largely underrecognised and hence undertreated in nursing homes in Tunisia as in other countries. Routine screening for cognitive deficits seems paramount in order to ensure early diagnosis and treatment of this debilitating condition.

In 1996, hand hygiene has been at the heart of the concerns of hospital staff of El Alia. Starting from a local action, the team was heavily involved in the development and implementation of the Tunisian national hand hygiene program that now has more than ten years.

Introduction Supersensitivity psychosis is a drug-induced phenomenon which consists of psychotic relapse occurring upon decrease or withdrawal of antipsychotics. This phenomenon has been described with many antipsychotics. We report the case of supersensitivity psychosis associated with decreasing doses of aripiprazole in a Tunisian patient. Case description Mr. M. is a 26-year old Tunisian male with a diagnosis of bipolar disorder (DSM IV). He was diagnosed at the age of 17. For the last 2 years, his condition was stable with lithium 250 mg/day, valproic acid 500 mg/day and aripiprazole 15 mg/day. The patient had a good adherence to this regimen and could go to work and study. During that period he only had some depressive relapses. He never had psychotic symptoms. He decided himself to stop taking aripiprazole. The withdrawal was abrupt. Two days later, he began to experience auditory and visual hallucinations and persecutory delusion he never experienced before. He was hospitalized and he was put again on aripiprazole with increased doses to 20 mg/day. One week later his symptoms had improved significantly, he was experiencing less hallucinations. Two weeks later all the psychotic symptoms disappeared. Discussion This case illustrates the concept of supersensitivity psychosis. This concept refers to the proposal that chronic administration of dopamine-blocking agents increases sensitivity of dopamine receptors in the mesolimbic or mesocortical system. These dopamine-blocking agents over-react to normal levels of dopamine after drug discontinuation or reduction, thus producing psychotic symptoms, analogous to the proposed mechanism of tardive dyskinesia.

Context Recognition deficits in facial affect tend to be regarded as a vulnerability marker in schizophrenia. Unlike complex electrophysiological markers, recognition of facial emotions is relatively easy to assess and could be a useful test to identify individuals at risk. Objective To assess the recognition of facial emotions in a Tunisian population, confirming deficit in patients with schizophrenia unlike controls, and to a lesser level in their first-degree relatives. Performance of the designed test, as a vulnerability marker, was discussed. Methodology One test was constructed from photographs of a famous actress face representing the Ekman's six basic emotions: happiness, anger, disgust, sadness, fear, and surprise. Maximum score was six. The test involves first the recognition of gender. This test has been proposed to three groups: one group of patients with schizophrenia (n = 34), a group of first-degree relatives (n = 27) and a control group (n = 57). Results Recognition deficits of emotions have been found in both patients and their first-degree relatives. Those recognition deficits were absent in the control group regardless of age, sex and educational level. The results also showed that this test is quite specific (77%) and sensitive (84%). Conclusion The findings suggest that patients with schizophrenia and their first-degree relatives are impaired of facial emotion recognition skills when compared with controls. This impairment may be a reflected endophenotype, and the constructed visual test should be used as a screening tool for people at risk of schizophrenia.

Voltage-sensitive calcium channels (VSCC) are a family of ionophores having different electrical and pharmacological properties. The omega-conotoxin GVIA (omega-CgTX) is a specific blocker of one subset of VSCCs. Because of the specificity of this toxin, a monoclonal anti-omega-CgTX antibody was generated against a omega-CgTX-key hole limpet hemocyanin conjugate and used as a specific marker to study VSCC distributions. This mab was shown to recognize omega-CgTX on Western blots and to display omega-CgTX-dependent immunoperoxidase staining of rat cerebellum. Incubation of fresh, unfixed sections of adult rat cerebellum in omega-CgTX followed by light fixation and peroxidase immunocytochemistry with mab anti-omega-CgTX revealed a specific pattern of labelling. All principal classes of cerebellar neurons were immunoreactive, but in general glial cells were not stained. Most interestingly, strong focal immunoreactivity was encountered at branching points of Purkinje cell dendrites. This characteristic staining pattern implies that a subset of VSCC is specifically concentrated in these regions and suggests that these channels may play a role in the functional integration of dendritic signals.

Electrophysiological mapping of the rat cerebellar cortex has revealed an elaborate functional somatotopy that tract tracing procedures have shown to correlate with specific patterns of afferent and efferent connectivity that encompass the cerebellum as a whole. In contrast, most anatomical and biochemical procedures suggest that the cerebellar cortex is remarkably uniform. To unmask covert molecular heterogeneity underlying the functional map, it is appropriate to use monoclonal antibody technology to search for antigenic epitopes whose cerebellar distribution reflects or encodes the positional information. Given that no preconditions can be set on the biochemical nature of the putative epitopes, a shotgun approach to immunization and screening is required. The construction of monoclonal antibodies and screening for specificities that reveal positional information is discussed with examples from an anti-cerebellar antibody library.

IntroductionCovid-19 pandemic represents a sanitary crisis with social, economic and political negative impacts. Studies had well established the link between stress and the display or maintenance of addictive behaviour. Measures like social distancing and confinement imposed by governments during this pandemic, could explain an outbreak of internet addiction cases.ObjectivesAssess the prevalence of internet addiction in times of the covid-19 pandemic and to study its relationship with personal and family factors but also with the psychiatric comorbidities.MethodsWe conducted a cross sectional analytical study during the period of the covid-19 pandemic, using an internet survey exploring socio-demographic and clinical data: through Hamilton depression and anxiety rating scale and the Rosenberg self esteem scale. The assessment of internet addiction was carried out using Young’s Internet Addiction test.ResultsOur study included 150 users, the average age was 36 years, mainly made up of women, married, having children, with a good socioeconomic level and of university education. The prevalence of depressive and anxious symptoms were respectively 7.3% and 18.7%. The prevalence of internet addiction in our study was 9.4% including 0.7% having severe repercussions. Being married (pConclusionsInternet addiction is a new concept, though it’s impact on the well being is well established and it’s likely to worsen in times of pandemic. Therefore, it’s necessary to take preventive measures to deal with it.DisclosureNo significant relationships.