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Abstract Objective To develop a high‐throughput sequencing panel for the diagnosis of developmental and epileptic encephalopathy in Tunisia and to clarify the frequency of disease‐causing genes in this region. Methods We developed a custom panel for next‐generation sequencing of the coding sequences of 116 genes in individuals with developmental and epileptic encephalopathy from the Tunisian population. Segregation analyses and in silico studies have been conducted to assess the identified variants' pathogenicity. Results We report 12 pathogenic variants in SCN1A, CHD2, CDKL5, SZT2, KCNT1, GNAO1, PCDH19, MECP2, GRIN2A, and SYNGAP1 in patients with developmental and epileptic encephalopathy. Five of these variants are novel: “c.149delA, p.(Asn50MetfsTer26)” in CDKL5; “c.3616C > T, p.(Arg1206Ter)” in SZT2; “c.111_113del, p.(Leu39del)” in GNAO1; “c.1435G>C, p.(Asp479His)” in PCDH19; and “c.2143delC, p.(Arg716GlyfsTer10)” in SYNGAP1. Additionally, for four of our patients, the genetic result facilitated the choice of the appropriate treatment. Significance This is the first report of a custom gene panel to identify genetic variants implicated in developmental and epileptic encephalopathy in the Tunisian population as well as the North African region (Tunisia, Egypt, Libya, Algeria, Morocco) with a diagnostic rate of 30%. This high‐throughput sequencing panel has considerably improved the rate of positive diagnosis of developmental and epileptic encephalopathy in the Tunisian population, which was less than 15% using Sanger sequencing. The benefit of genetic testing in these patients was approved by both physicians and parents.

Abstract Background The aim of this study was to investigate the relationship between Problematic Internet Use (PIU), emotional states of stress, anxiety and depression, and the practice of physical activity among Tunisian students. Methods Cross-sectional data were collected from 976 university students aged 20.76 ± 1.63 years (46.8% female). They filled out an online survey comprised of a socio-demographic questionnaire, the depression, anxiety and stress scale– 21 items (DASS-21), the international physical activity questionnaire (IPAQ) and the compulsive internet use scale (CIUS). Students were divided, based on their economic levels, into three groups: low (n = 256, 26.23%), medium (n = 523, 53.59%) and high (n = 197, 20.18%). Results Mediation analysis: Indirect effects of IPAQ and gender on DASS-21 were highlighted: β= -0.18 (p

IntroductionSignificant therapeutic changes have recently occurred in the management of melanoma brain metastases (BMs), both in the field of local treatments, with the rise of stereotactic radiotherapy (RT), as well as in systemic ones, with the advent of immunotherapy and targeted therapies (TT). These advances have brought about new challenges, particularly regarding the potential interactions between new TT (notably BRAF/MEK inhibitors) and irradiation. Through a clinical case, we will discuss a side effect not previously described in the literature: ultra-early pseudoprogression (PP) following brain stereotactic radiosurgery (SRS), in a patient treated with dabrafenib-trametinib.Case presentationA 61-year-old patient with BRAFV600E-mutated melanoma, receiving second-line dabrafenib-trametinib therapy, was referred for SRS on three progressing meningeal implants, without evidence of systemic progression. Four days after the first RT session (1x6 Gy on a fronto-orbital lesion prescribed 5x6 Gy, and 1x20 Gy single fraction on the other lesions), the patient presented with an epileptic seizure. An MRI, compared to the planning MRI ten days earlier, revealed significant progression of the irradiated lesions. The patient’s condition improved with dexamethasone and levetiracetam, and RT was halted out of caution. A follow-up MRI at one month demonstrated a size reduction of all treated lesions. Subsequent imaging at five months revealed further shrinking of the two lesions treated with an ablative dose of 20 Gy, while the under-treated fronto-orbital lesion progressed. These dynamics suggest an initial PP in the three irradiated lesions, followed by good response in the ablatively treated lesions and progression in the partially treated lesion.ConclusionTo our knowledge, this represents the first documented case of ultra-early PP following brain SRS in a patient receiving concomitant dabrafenib-trametinib. It highlights the need for particular vigilance when using tyrosine kinase inhibitors (TKIs) with SRS, and warrants further research into potential treatment interactions between RT and novel systemic agents, as well as the optimal treatment sequence of melanoma BMs.

Toxic metals in water systems pose a global health risk. Thus, multifunctional water monitoring and treatment materials are indispensable. Nickel ions, a frequent heavy metal pollutant, affect ecosystem function. However, developing affordable, functional materials for efficient heavy metal removal remains problematic. This study investigates the utilization of Al2O3@g-C3N4 (AlCN) nanosorbent for adsorbing Ni (II) ions from aqueous solutions. The physicochemical analyses verify the creation of an AlCN nanosorbent with a mean size of 31.25 nm crystals and a specific surface area of 58 m2/g. Batch adsorption experiments were conducted to examine the impact of pH, initial Ni (II) concentration, and adsorbent dose on the efficiency of Ni (II) removal using the synthesized (AlCN) nanosorbent. Adding Al2O3 to g-C3N4 nanosheets increased the adsorption capacity to a maximum of 410 mg/g under ideal conditions, as demonstrated by the results. Ni (II) ions adsorption kinetics on AlCN nanosorbents follow the pseudo-second-order kinetic model with an R2 value of 0.99, surpassing the Elovich pseudo-first model. The adsorption isotherm results show that the Langmuir model fits the experimental data better than the Freundlich and Temkin models, indicating a monolayer adsorption process for the AlCN nanosorbent. In addition, the AlCN exhibited multi-elemental adsorption ability and good recyclability. These findings can nominate the fabricated composite as a candidate for water treatment.

Abstract Patient-derived xenograft (PDX) models are widely used in cancer research. To investigate the genomic fidelity of non-small cell lung cancer PDX models, we established 48 PDX models from 22 patients enrolled in the TRACERx study. Multi-region tumor sampling increased successful PDX engraftment and most models were histologically similar to their parent tumor. Whole-exome sequencing enabled comparison of tumors and PDX models and we provide an adapted mouse reference genome for improved removal of NOD scid gamma (NSG) mouse-derived reads from sequencing data. PDX model establishment caused a genomic bottleneck, with models often representing a single tumor subclone. While distinct tumor subclones were represented in independent models from the same tumor, individual PDX models did not fully recapitulate intratumor heterogeneity. On-going genomic evolution in mice contributed modestly to the genomic distance between tumors and PDX models. Our study highlights the importance of considering primary tumor heterogeneity when using PDX models and emphasizes the benefit of comprehensive tumor sampling.

Abstract Background Artemisia campestris L. (AC) leaves are widely recognized for their importance in traditional medicine. Despite the considerable amount of research conducted on this plant overworld, the chemical composition and the biological activity of the leaves grown in Tunisia remains poorly investigated. In this study of AC, a successive extraction method was employed (hexane, ethyl acetate and methanol) to investigate its bioactive constituents by LC-MS analysis, and their antioxidant, antibacterial, antifungal, and anticancer activities. Results Data analysis revealed diverse compound profiles in AC extracts. Methanolic and ethyl acetate extracts exhibited higher polyphenolic content and antioxidant activities, while Hexane showed superior phytosterol extraction. Ethyl acetate extract displayed potent antibacterial activity against multi-resistant Staphylococcus aureus and Pseudomonas aeruginosa. Additionally, all extracts demonstrated, for the first time, robust antifungal efficacy against Aspergillus flavus and Aspergillus niger. Cytotoxicity assays revealed the significant impact of methanolic and ethyl acetate extracts on metastatic breast cancer and multiple myeloma, examined for the first time in our study. Moreover, further analysis on multiple myeloma cells highlighted that the ethyl acetate extract induced apoptotic and necrotic cell death and resulted in an S phase cell cycle blockage, underscoring its therapeutic potential. Conclusions This investigation uncovers novel findings in Tunisian AC, notably the identification of lupeol, oleanolic acid, ursolic acid, stigmasterol and β-sitosterol. The study sheds light on the promising role of AC extracts in therapeutic interventions and underscores the need for continued research to harness its full potential in medicine and pharmaceutical development.

Abstract Background This study aimed to compare various factors, namely perceived enjoyment (PE), percentage of peak heart rate (%HRpeak), blood lactate (La), rating of perceived exertion (RPE), and technical-tactical performance among soccer players across different bout durations (CB: continuous bout, MIB: medium intermittent bouts, and SIB: short intermittent bouts) and between male and female players during four-a-side (4vs4) small-sided games (SSGs) including goalkeepers. Methods sixteen female soccer players (age: 20.1 ± 0.5 years old) and sixteen professional male adults (age: 20.7 ± 0.7 years old) participated in the study. SSGs (4vs4) were performed in a CB: (1 × 12 min), and in an interval format: MIB: (2 × 6 min), and SIB: (3 × 4 min) with 2 min of passive recovery. PE was collected after each SSGs. The players’ heart rate (HR) was continuously measured, whereas ratings of perceived exertion (RPE) and, blood lactate concentration ([La]) were determined at the end of each SSGs. Technical-tactical performance were analyzed during each session of SSGs. Pitch dimensions were (length x width) (25 × 32 m), and relative space per players was 100 m2. Results For female soccer players, medium intermittent bouts (MIB) elicited significantly higher perceived enjoyment (PE) compared to continuous bouts (CB) (p

The present study describes ultrasonically produced ternary composite material composed of carbon nitride nanosheets, zirconium, and titanium oxides for elimination of copper ions. The formation of monoclinic ZrO2, anatase TiO2, and g-C3N4 phases with respective crystallite sizes 6, 11, 13 nm were verified by the X-ray diffraction technique. The dispersion of the metal oxides nanoparticles with the graphitic nanosheets, the elemental composition of Zr, Ti, O, C and N, and the characteristic functional groups were verified respectively by TEM, EDX, and FTIR analysis that confirmed the successful formation and composition of the nanocomposite TiO2–ZrO2@g-C3N4 (TZCN). The good porosity of the composite that show a surface area, pore volume, and pore diameter values of 47.42 m2/g, 0.056 cm3 g−1, and 20.3 Å that nominate it for adsorption application. The adsorption capabilities of the nanocomposite were studied for copper ion removal from an aqueous solution, as well as the impacts of pH and starting Cu2+ concentration. The results show that the adsorption process is pH and starting concentration-dependent, with a maximum adsorption capacity of 447.8 mg/g. The Cu2+ adsorption is a monolayer chemisorption process that is well described by the Langmuir adsorption model and follows pseudo-second-order kinetics. Moreover, a plausible mechanism for Cu2+ ion adsorption on the surface of TZCN nanocomposite particles is proposed.

AbstractNo Arabic version of the Revised Cognitive-Affective Mindfulness Scale (CAMS-R) was found, prompting this study’s threefold objectives: first, to validate an Arabic translation of CAMS-R among Tunisian students; second, to assess its factor structure and reliability; and third, to explore its validity by investigating the relationship between CAMS-R scores, grit, and academic success. Cross-sectional online data were collected from 705 university physical education students (mean age 21.62 ± 1.38 years) in two distinct time periods, with participants divided into exploratory and confirmatory samples. The 12-item CAMS-R scale underwent both exploratory factor analysis and confirmatory factor analysis (CFA), confirming a second-order structure (χ2 (53) = 77.997, p = 0.014; χ2/df = 1.47; Comparative fit index (CFI) = 0.995; CFI = 0.994; RMSEA (90% confidence interval [CI] 0–0.013–0.042) = 0.029. Strong internal consistency was indicated by Cronbach α indices ranging from 0.865 to 0.880 for all subscales. Results from ROC curve analysis revealed the Arabic CAMS-R’s ability to distinguish effectively between students with low and high-grade point averages (GPA; area under the curve [AUC] = 0.782, CI 95%: 0.726–0.838, p

The classification of motor imagery (MI) using Electroencephalography (EEG) plays a pivotal role in facilitating communication for individuals with physical limitations through Brain-Computer Interface (BCI) systems. Recent strides in Attention-Based Networks (ATN) have showcased remarkable performance in EEG signal classification, presenting a promising alternative to conventional Convolutional Neural Networks (CNNs). However, while CNNs have been extensively analyzed for their resilience against adversarial attacks, the susceptibility of ATNs in comparable scenarios remains largely unexplored. This paper aims to fill this gap by investigating the robustness of ATNs in adversarial contexts. We propose a high-performing attention-based deep learning model specifically designed for classifying Motor Imagery (MI) brain signals extracted from EEG data. Subsequently, we conduct a thorough series of experiments to assess various attack strategies targeting ATNs employed in EEG-based BCI tasks. Our analysis utilizes the widely recognized BCI Competition 2a dataset to demonstrate the effectiveness of attention mechanisms in BCI endeavors. Despite achieving commendable classification results in terms of accuracy (87.15%) and kappa score (0.8287), our findings reveal the vulnerability of attention-based models to adversarial manipulations (accuracy: 9.07%, kappa score: -0.21), highlighting the imperative for bolstering the robustness of attention architectures for EEG classification tasks.

IntroductionThis study investigates the effects of teacher verbal encouragement (VE) on strength, endurance, and psychophysiological responses, aiming to enhance teaching strategies in sports science education.MethodsForty-eight sports science students, aged 21.3 ± 0.5 years, participated in this study. The sample was randomly divided into two groups, and a counterbalancing procedure was implemented. Participants completed strength and endurance testing sessions under normal conditions in the first week and repeated similar sessions in the second week with teacher VE. Strength was assessed using the 1RM bench press, squat, and deadlift tests, while endurance was evaluated through 8-minute time trials (8MTT: burpees, box jumps, hand-release push-ups, and sit-ups). Perceived exertion and physical activity enjoyment were investigated using self-reporting instruments.ResultsThe key findings showed that participants lifted greater weights in the 1RM bench press (p

Precision Medicine is being increasingly used in the developed world to improve health care. While several Precision Medicine (PM) initiatives have been launched worldwide, their implementations have proven to be more challenging particularly in low- and middle-income countries. To address this issue, the “Personalized Medicine in North Africa” initiative (PerMediNA) was launched in three North African countries namely Tunisia, Algeria and Morocco. PerMediNA is coordinated by Institut Pasteur de Tunis together with the French Ministry for Europe and Foreign Affairs, with the support of Institut Pasteur in France. The project is carried out along with Institut Pasteur d’Algérie and Institut Pasteur du Maroc in collaboration with national and international leading institutions in the field of PM including Institut Gustave Roussy in Paris. PerMediNA aims to assess the readiness level of PM implementation in North Africa, to strengthen PM infrastructure, to provide workforce training, to generate genomic data on North African populations, to implement cost effective, affordable and sustainable genetic testing for cancer patients and to inform policy makers on how to translate research knowledge into health products and services. Gender equity and involvement of young scientists in this implementation process are other key goals of the PerMediNA project.In this paper, we are describing PerMediNA as the first PM implementation initiative in North Africa. Such initiatives contribute significantly in shortening existing health disparities and inequities between developed and developing countries and accelerate access to innovative treatments for global health.

The rise of artificial intelligence (AI) applications in healthcare provides new possibilities for personalized health management. AI-based fitness applications are becoming more common, facilitating the opportunity for individualised exercise prescription. However, the use of AI carries the risk of inadequate expert supervision, and the efficacy and validity of such applications have not been thoroughly investigated, particularly in the context of diverse health conditions. The aim of the study was to critically assess the efficacy of exercise prescriptions generated by OpenAI’s Generative Pre-Trained Transformer 4 (GPT-4) model for five example patient profiles with diverse health conditions and fitness goals. Our focus was to assess the model’s ability to generate exercise prescriptions based on a singular, initial interaction, akin to a typical user experience. The evaluation was conducted by leading experts in the field of exercise prescription. Five distinct scenarios were formulated, each representing a hypothetical individual with a specific health condition and fitness objective. Upon receiving details of each individual, the GPT-4 model was tasked with generating a 30-day exercise program. These AI-derived exercise programs were subsequently subjected to a thorough evaluation by experts in exercise prescription. The evaluation encompassed adherence to established principles of frequency, intensity, time, and exercise type; integration of perceived exertion levels; consideration for medication intake and the respective medical condition; and the extent of program individualization tailored to each hypothetical profile. The AI model could create general safety-conscious exercise programs for various scenarios. However, the AI-generated exercise prescriptions lacked precision in addressing individual health conditions and goals, often prioritizing excessive safety over the effectiveness of training. The AI-based approach aimed to ensure patient improvement through gradual increases in training load and intensity, but the model’s potential to fine-tune its recommendations through ongoing interaction was not fully satisfying. AI technologies, in their current state, can serve as supplemental tools in exercise prescription, particularly in enhancing accessibility for individuals unable to access, often costly, professional advice. However, AI technologies are not yet recommended as a substitute for personalized, progressive, and health condition specific prescriptions provided by healthcare and fitness professionals. Further research is needed to explore more interactive use of AI models and integration of real-time physiological feedback.

Water pollution represents one of the most important problems affecting the health of living organisms, so it was necessary to work on the formation of active materials to get rid of pollutants. In this study, Titanium dioxide (TiO2) doping Zinc oxide (ZnO) nanocomposites were produced via simple sonication method at 500 Hz in ethanol medium. At different weight concentrations (2.5, 5, 7.5, and 10 %). The morphology, structure configuration, chemical bonding, crystalline phase, and surface properties of obtained nanocomposites were characterized via FESEM, BET, XRD, XPS, RAMAN and FTIR instrumentation. The nanocomposites were employed as an adsorbent to eliminate the methyl orange (MO) and Indigo Carmine (IC) dyes from an aqueous solution. Batch removal experiments revealed that the elimination of MO and IC dyes by the TiZnO surface was pH and doping Ti concentration-dependent, with maximum removal occurring at pH = 7 for MO and pH = 3 for IC contaminants at 10 % doping Ti concentration (Ti (10 %)@ZnO). Langmuir model fit the absorptive removal of MO and IC dyes into the Ti (10 %)@ZnO surface well. The maximal removal capacity of Ti (10 %)@ZnO nanocomposite was found to be 994.24 mg. g−1 for MO and 305.39 mg. g−1 for IC. The Ti (10 %)@ZnO nanocomposite showed remarkable high stability towards the removal of both dyes through consecutive four cycles.

Introduction Sleep disruptions are frequently observed in individuals with bipolar disorder and have been linked to various unfavorable consequences, such as an elevated risk of relapse and lower quality of life. Nonetheless, the impact of sociodemographic factors on the development and progression of these disruptions remains largely unexplored. Gaining insight into the relationship between sleep disruptions and sociodemographic factors is essential for designing effective interventions and enhancing clinical outcomes for individuals affected by bipolar disorder Objectives The objective of this study is to examine the association between sleep disorders in patients with bipolar disorder II (BDII) and sociodemographic characteristics. Methods This is a cross-sectional, descriptive, and analytical study that was conducted over a one-month period from October 1 to October 31, 2022, with patients attending the follow-up unit of the mental health department at Nabeul Hospital ,Tunisia.The study employed a questionnaire as a tool for data collection, and participants provided voluntary and informed consent before responding. The protection of participant confidentiality and anonymity was carefully observed during all stages of the study. Results In this study, we enrolled patients who satisfied the following eligibility criteria: age range of 18 to 60 years, a confirmed diagnosis of type II bipolar disorder based on DSM V criteria, and psychiatric stability as demonstrated by no hospitalization within the preceding 6-month period. Our study included a sample of 40 male patients diagnosed with type II bipolar disorder. The participants had a mean age of 36 ± 13.2 years, and the majority were unmarried and living with their families or alone. Over two-thirds of the participants had attained a university level of education, while a large proportion of the patients, specifically 80%, reported being regular smokers. The results of the study revealed that the mean global score on the Pittsburgh Sleep Quality Index (PSQI) was 7.28 ± 3.35, indicating an overall low quality of sleep. The majority of the participants, that is 65% (26), had poor sleep quality scores (> 5), while 45% (18) reported experiencing poor sleep (PSQI ≥ 8). Our analyses further demonstrated that there was a significant association between tobacco consumption and PSQI scores (p=0.003). Additionally, we found that participants who were above 40 years old had a higher likelihood of experiencing sleep disturbances (p=0.0017). Conclusions According to the findings of our study, it appears that patients diagnosed with type II bipolar disorder may experience impaired sleep quality, which can be influenced by age and tobacco consumption. These results underscore the need for a holistic approach to patient care that addresses both the biological and sociodemographic factors that can impact sleep in this population. Disclosure of Interest None Declared

Introduction One of the common symptoms of schizophrenia is sleep disturbances, which can have a significant impact on the quality of life of patients. Several studies suggest the existence of a complex link between sleep disorders and agressive behavior in patients with schizophrenia. Objectives to determine the impact of sleep disorders on aggressive behavior in patients with schizophrenia. Methods We conducted a cross-sectional, descriptive, and analytical study that took place over a period of one month (from 1st to 31nd March 2023) with patients consulting the post-cure of Psychiatry Service D at Razi Hospital, Tunisia. We included patients diagnosed with schizophrenia according to DSM5, and stabilized on a psychiatric plan. We used the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality over a period of one month. The Buss & Perry Aggression Questionnaire (QABP) was used to measure aspects of aggression. We used the Adult Social Relationships Scales (ASRS), part of the National Institute of Health (NIH) toolkit, assessing six domains of social relationships: perceived rejection, perceived hostility, loneliness, friendship, instrumental support and emotional support. Results We collected data from 40 male patients with a mean age of 42.5 ± 14.02. The mean global PSQI score was 9.23 ± 4.58. Ten patients were on typical antipsychotics, 25 patients were on atypical antipsychotics, and the remaining five patients were on a combination therapy (both atypical and typical antipsychotics). Regarding the use of benzodiazepines, 34 patients were taking lorazepam at a dose of 2.5 to 5 mg per day. he mean QABP global score was 45 ± 12.3 out of 72. For the subjective evaluation, all patients self-reported feeling “irritable,” “dysphoric,” “unable to communicate with others,” and “wanting to break objects” when they experienced insomnia. We found a statistically significant association between QABP and daytime dysfunction (p=0.003). The overall PSQI score was higher, and statistically significantly associated, in patients who reported low emotional support (p=0.018) and perceived social rejection (p=0.04). Conclusions An integrated approach that includes the evaluation of sleep disorders, as well as the prevention and management of violence, can play a key role in the overall improvement of the mental health of patients with schizophrenia. Disclosure of Interest None Declared

Introduction Hyperthyroidism, characterized by excessive production of thyroid hormones, is a common endocrine disorder that affects various body systems. While most commonly recognized for its classic symptoms such as weight loss, tremors, and palpitations, it is important to acknowledge that hyperthyroidism can also lead to a rare but significant complication: psychosis. Psychosis in the context of hyperthyroidism refers to the presence of delusions, hallucinations, and disordered thinking, which can significantly impact an individual’s mental health and overall well-being. Objectives This case report aims to describe a rare case of hyperthyroidism-related psychosis in a patient including the clinical presentation, diagnosis, and management. Additionally, we aim to increase awareness of and promote further research into this condition. Methods We present a comprehensive case report detailing the clinical course of a 29-year-old male patient with no previous medical or psychiatric history, who sought urgent psychiatric evaluation at the Razi Hospital La Manouba’s emergency department due to escalating symptoms of agitation and paranoia persisting for three days. The patient, identified as Mr. S.O., a Tunisian male, presented with severe agitation and paranoia necessitating the use of restraints upon admission to the psychiatric emergency department. The initial physical examination revealed no notable abnormalities, except for the presence of tachycardia, which was subsequently confirmed on an electrocardiogram, arousing suspicion of a primary psychiatric illness. Results While the standard blood workup yielded unremarkable findings, the endocrine workup revealed decreased levels of thyroid-stimulating hormone (TSH) and elevated free thyroxine (FT4). Further laboratory investigations demonstrated elevated anti-thyroid-stimulating hormone receptor antibodies, leading to the diagnosis of Graves’ disease. Collaborative consultation with an endocrinologist resulted in the initiation of a treatment regimen consisting of methimazole, propranolol, and risperidone. Notably, within three days of the initiated therapy, the patient exhibited significant improvement in terms of reduced agitation, coherent speech, and the development of self-reflection regarding the episode, ultimately leading to his discharge on the seventh day of hospitalization. This case report serves to highlight the complexity of psychiatric presentations associated with underlying endocrine disorders and underscores the importance of interdisciplinary collaboration in achieving optimal patient outcomes. Conclusions While mental health factors play a significant role in the development of psychosis, it is essential to recognize that underlying medical conditions may also contribute to its onset or exacerbation. Disclosure of Interest None Declared

Introduction Sleep disturbances and suicidal behaviors are common among patients with type II bipolar disorder ( BDII), but the relationship between the two is unclear. Investigating this connection is important to identify interventions that can improve the quality of life and reduce the risk of suicide in this population. Objectives Our study’s objective is to examine the association between sleep disorders and suicidal behavior in patients with type II bipolar disorder (BDII). Methods In order to comprehensively investigate the association between sleep disturbances and suicidal behaviors among individuals diagnosed with type II bipolar disorder (TBII), we conducted a cross-sectional, descriptive, and analytical study over a duration of one month, specifically from the 1st to the 31st of October 2022. Our research was conducted within the follow-up unit of the mental health department at Nabeul Hospital, Tunisia, with the aim of capturing a diverse range of participants representative of the population of interest. To ensure the integrity and accuracy of our findings, we meticulously selected participants who met specific eligibility criteria. This included individuals aged between 18 and 60 years, who had a confirmed diagnosis of type II bipolar disorder according to the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM V). Furthermore, we sought to include participants who were psychiatrically stable, meaning they had not required hospitalization in the six months preceding the study. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the participants’ sleep quality over a one-month period, while the Suicidal Behavior Questionnaire-Revised (SBQ-R) was used to assess suicidal behavior.The data was gathered through a questionnaire that prioritized ethical concerns, including obtaining informed consent from participants and maintaining confidentiality and anonymity throughout the study. Results In this study, we enrolled 40 male patients with a mean age of 36 ± 13.2 years and evaluated their sleep quality and suicidal behaviors. The results showed that the participants had a mean PSQI score of 7.28 ± 3.35, indicating that the overall sleep quality was not optimal. Specifically, 65% of the participants had poor sleep quality (> 5), and 45% reported poor sleep(PSQI ≥ 8) . The mean SBQ-R score was 10.3 ± 3.6, indicating a moderate level of suicidal behavior. Interestingly, we found a statistically significant correlation between PSQI and SBQ-R subscales, particularly with regard to suicidal thoughts (p=0.003) and suicide attempts (p=0.002). Conclusions Our study found a strong link between sleep problems and suicidal behavior in people with type II bipolar disorder. This highlights the need to address sleep issues to reduce suicide risk in these patients. Disclosure of Interest None Declared

Introduction Several factors can influence the journey of perinatal grief in mothers, including the quality of care during this experience. The objective of our study was to investigate the factors influencing the perception of grieving women during the perinatal period and identify the role of medical and paramedical healthcare professionals in psychological support. Objectives To determine the factors influencing the perception of fetal loss in grieving mothers. Methods This was a descriptive, longitudinal, retrospective study conducted between july 2021 and march 2022 at the Fetal Pathology Department of the Center for Maternity and Neonatology in Tunis, Tunisia. The study included women who experienced perinatal loss and underwent fetal pathology examination. The study was conducted in two stages: Initial consultation at the Fetal Pathology Department, five weeks after the date of expulsion, for perinatal grief counseling. Follow-up interview one year after the date of expulsion: The participants were contacted via telephone for an average duration of twenty minutes .The assessment of perinatal grief during both interviews was conducted using the shortened version of the Perinatal Grief Scale (PGS) Results The mean age of the patients was 31.41 years (± 5.15). The average gravidity was 2.47 (± 1.43). More than half of the patients had no living children (n=41). The majority of patients had no notable pathological history. Six patients had been followed in psychiatry, and five had a history of subfertility. The majority of patients (n=61) reported having good marital relationships. Among the participants, 20% (n=14) had a high Perinatal Grief Scale (PGS) score (PGS >= 91) at five weeks post-loss and were subsequently referred for psychiatric consultation. At one year, all participants had a PGS score > 91, demonstrating the effectiveness of psychiatric management. Multivariate analysis identified four independent factors associated with a high PGS score at five weeks: absence of living children (OR=0.59; 95% CI [0.36-0.98]; p=0.04), quality of marital relationship (OR=1.2; 95% CI [1.1-3.9]; p=0.02), family support (OR=2.52; 95% CI [1.55-4.12]; p

Introduction Sleep disorders are a significant concern for patients with schizophrenia, and they can have a profound impact on their quality of life. Studies have shown that sleep disturbances are prevalent in patients with schizophrenia, and they may be linked to the clinical characteristics of the disorder. Despite this, the exact nature of the relationship between sleep disorders and schizophrenia remains unclear. Understanding this relationship is critical as it may lead to better diagnosis and treatment of both conditions, ultimately improving the overall health and wellbeing of patients. Objectives To establish the link between sleep disorders and clinical characteristics in a clinical population being treated for schizophrenia. Methods We conducted a cross-sectional, descriptive, and analytical study that took place over a period of one month (from 1st to 31nd March 2023) among patients consulting the post-care service of Psychiatry Department D at Razi Hospital, Tunisia. We included patients aged between 18 and 65 years, diagnosed with schizophrenia according to DSM-5, and stabilized on psychiatric treatment. We used the Pittsburgh Sleep Quality Index (PSQI) to evaluate sleep quality over a period of one month. The evaluation of the clinical characteristics of schizophrenia was carried out using the Positive and Negative Syndrome Scale (PANSS). The interview was conducted by a single researcher, and when the questionnaire was distributed to the participants, we explained the framework and the principle of this study as well as the implications of participating in it and explained that the participant could stop participating at any time if he or she wished. Results We collected data from 30 male patients with a mean age of 42.5 ± 14.02. The mean overall PSQI score was 9.23 ± 4.58. The subscales evaluating the subjective quality of sleep obtained an average score of 1.42 ± 0.72, sleep latency was 1.61 ± 1.33, sleep duration was 1.01 ± 0.98, habitual sleep efficiency was 0.67 ± 0.75, sleep disturbances were 0.91 ± 0.52, sleep medication use was 1.36 ± 1.68, and daytime dysfunction was 1.12 ± 0.96. The mean scores of PANSS were: positive scale (28.26 ± 5.93), negative scale (18 ± 6.15), and general psychopathology scale (90.03 ± 16.21). We found a statistically significant association between the positive PANSS scale and sleep latency (p=0.002) and sleep medication use (p

Introduction Schizophrenia is a debilitating mental illness that can cause significant disruptions in a person’s life, leading to difficulty with thinking, emotions, and behaviors. While the symptoms of schizophrenia are well-known and extensively studied, comorbidities like eating disorders are often overlooked and undertreated, despite their prevalence in patients with schizophrenia. Objectives determine the different eating attitudes among schizophrenic patients and establish the link between eating attitudes, age, weight status, and psychotropic medication. Methods This is a cross-sectional and descriptive study that took place from September to November 2022 among patients who consulted the post-care consultations of Psychiatry D service at Razi Hospital, Tunisia. We included patients who had been followed for at least one year for schizophrenia according to the diagnostic criteria of DSM-V and who had not relapsed for at least 2 months. The collection of sociodemographic and clinical data was done retrospectively by referring to the patients’ clinical records. Anthropometric measurements (weight, height, waist circumference, etc.) were recorded for each participant at the end of the interview. The Three-Factor Eating Questionnaire (TFEQ) was used to analyze eating attitudes. Results According to our results among 30 patients followed for schizophrenia, 74% were men with a mean age of 45 years (3.8). Sixty percent of the participants had a BMI

Introduction Female sexuality is a complex and multifactorial domain that can be influenced by a variety of psychological, biological, relational, and sociocultural factors. However, sexual dysfunctions in women remain a taboo subject in many cultures and are often underestimated, underdiagnosed, and undertreated. In Tunisia, few studies have been conducted to assess the prevalence of sexual dysfunctions in women and their predictive factors. Objectives to determine the prevalence of sexual dysfunctions in a group of Tunisian women and to identify the predictive factors of these dysfunctions. Methods This is a cross-sectional, descriptive, and analytical study, over a period of three months, from September to December 2022, conducted online via a pre-established questionnaire to collect various sociodemographic data, personal history, psychoactive substance consumption, weight, and height. We used the Female Sexual Function Index (FSFI) scale to evaluate sexual functioning in participants. We recruited sexually active Tunisian women over 18 years of age who agreed to anonymously respond to the questionnaire. The form was disseminated on social networks, in groups that focus on women, with a rate of three publications per week. Results We collected data from 90 women with a mean age of 35 ± 12.84 years. More than half of our population (60%, n=54) had at least one sexual dysfunction. The most common sexual dysfunctions reported were arousal disorders (31.3%), followed by desire disorders (26.8%) orgasm disorders (12.4%). We found that several factors were significantly associated with sexual dysfunctions : Women over 45 years of âge (p

By shifting the portability task away from a mobile network node and onto a mobile router, the NEMO BS protocol has been given the green light to run by the Internet Engineering Task Force (IETF) working group. It is not effective to anticipate the mobility of each node in a train, bus, or ship individually. Hence, it would be reasonable to hire a Mobile Router (MR) that collectively handles the mobility of the entire mobile network. The NEMO BS protocol encourages efficient mobility for groups. Devices on a mobile network do not recognize the mobility of their network. Uninterrupted Internet connectivity is still given to mobile network nodes (i.e. the devices) despite the fact that the network's connection point is shifted on the Internet. The NBS solution has severe performance limitations (e.g. triangular routing and signalling cost). To address the aforementioned issues, the Diff-FH NEMO pattern has formerly been proposed. This article built a methodology to evaluate signalling costs for major Diff-FH NEMO entities. For verification, the effectiveness of the proposed scheme Diff-FH NEMO is measured against that of the industry-standard NEMO BS protocol and the MIPv6-based Route Optimization (MIRON) scheme. Many important indicators, such as the length of time a user spends in a subnet and the total number of hops, are used to compare the signalling cost to (DiffServ Mobile Router (DMRs), Correspondent Nodes (CNs), Local Fixed Nodes (LFNs), and mobile nodes). The analytical findings indicate that the suggested approach gained considerable act enhancement by shrinking the total signalling cost when the network size was enlarged.

Hilmi Jelleli,1 Omar Hindawi,2 Mahmoud Rebhi,1,3 Mohamed Ben Aissa,1 Mouna Saidane,1,4 Amr Roushdy Saad,5 Noomen Guelmami1,6 1Department of Human and Social Sciences, Higher Institute of Sport and Physical Education of Kef, University of Jendouba, Jendouba, Tunisia; 2Faculty of Physical Education and Sport Science, Sport Rehabilitation Department, The Hashemite University, Zarqa, Jordan; 3Department of Education, Higher Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia; 4Department of Health, Higher Institute of Nursing Sciences of Kef, University of Jendouba, Jendouba, Tunisia; 5Faculty of Physical Education of Mansoura, University of Mansoura, Mansoura, Egypt; 6Postgraduate School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, ItalyCorrespondence: Hilmi Jelleli, Higher Institute of Sport and Physical Education of Kef, University of Jendouba, Jendouba, Tunisia, Tel +201695537471, Email h.jelleli@gmail.comPurpose: Nomophobia refers to a psychological state in which individuals experience anxiety or fear at the thought of being disconnected from their mobile phone. The Nomophobia Questionnaire was developed to assess dimensions of nomophobia among native English-speaking populations. The purpose of this study was to adapt and validate the Nomophobia Questionnaire in the Tunisian context based on Western Arabic dialects.Methods: This cross-sectional design using a non-probability sampling method was conducted from September 05 to October 06, 2022. A total of 644 participants, with an average age of 21.04 ± 1.59 years, completed a sociodemographic questionnaire and an Arabic version of the Nomophobia Questionnaire. Participants were divided into two groups to perform exploratory and confirmatory factor analysis. The first group consisted of 200 students (56% female and 44% male with an average age of 21.10 ± 1.64), with 33% (n = 66) freshmen, 41.5% second-year students (n = 83) and 25.5% (n = 51) of third-year students. The second group was collected one month later in the same establishment and was composed of 444 students (52% men and 48% female with an average age of 21.01 ± 1.57).Results: The results of the exploratory and confirmatory factor analysis showed that the 20 items and the second order four-factor structure should be retained. Confirmatory factor analysis of the Arabic version of the NMP-Q gave the following statistics: χ 2/df= 1.47; Fit Index = 0.997; Adjusted goodness-of-fit index = 0.996; Tucker-Lewis index = 1.003; Comparative Fit Index = 1; Root mean square error of approximation = 0.000 (90% CI 0– 0) and standardized mean residual = 0.030, indicating good model fit. McDonald’s ω internal consistency indexes for the four factors, namely giving up convenience, not being able to access information, not being able to communicate, and losing connectedness were 0.821, 0.841, 0.851, and 0.897, respectively. These values demonstrated good scale consistency.Conclusion: The Arabic Version of the Nomophobia questionnaire has been found to be a reliable and valid psychometric tool, and can be effectively used to measure nomophobia in countries where western Arabic dialects are spoken.Keywords: validation, mobile, inconvenience, students, sport

BackgroundPsychiatry is a specialized field of medicine that focuses on the diagnosis, treatment, and prevention of mental health disorders. With advancements in technology and the rise of artificial intelligence (AI), there has been a growing interest in exploring the potential of AI language models systems, such as Chat Generative Pre-training Transformer (ChatGPT), to assist in the field of psychiatry.ObjectiveOur study aimed to evaluates the effectiveness, reliability and safeness of ChatGPT in assisting patients with mental health problems, and to assess its potential as a collaborative tool for mental health professionals through a simulated interaction with three distinct imaginary patients.MethodsThree imaginary patient scenarios (cases A, B, and C) were created, representing different mental health problems. All three patients present with, and seek to eliminate, the same chief complaint (i.e., difficulty falling asleep and waking up frequently during the night in the last 2°weeks). ChatGPT was engaged as a virtual psychiatric assistant to provide responses and treatment recommendations.ResultsIn case A, the recommendations were relatively appropriate (albeit non-specific), and could potentially be beneficial for both users and clinicians. However, as complexity of clinical cases increased (cases B and C), the information and recommendations generated by ChatGPT became inappropriate, even dangerous; and the limitations of the program became more glaring. The main strengths of ChatGPT lie in its ability to provide quick responses to user queries and to simulate empathy. One notable limitation is ChatGPT inability to interact with users to collect further information relevant to the diagnosis and management of a patient’s clinical condition. Another serious limitation is ChatGPT inability to use critical thinking and clinical judgment to drive patient’s management.ConclusionAs for July 2023, ChatGPT failed to give the simple medical advice given certain clinical scenarios. This supports that the quality of ChatGPT-generated content is still far from being a guide for users and professionals to provide accurate mental health information. It remains, therefore, premature to conclude on the usefulness and safety of ChatGPT in mental health practice.