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Introduction Spondyloarthritis (SpA) is a common rheumatic inflammatory disease and can impact patients’ work productivity. We aimed to evaluate the impact of pain catastrophizing and central sensitization on work outcomes in young SpA patients and determine the predictive factors of work productivity loss. Material and methods We performed a cross-sectional study over 6 months. We included patients aged between 18 and 50 years old, diagnosed with axial or peripheral SpA. Pain catastrophizing and central sensitization were assessed using the Pain Catastrophizing Scale (PCS) and Central Sensitization Inventory (CSI) questionnaire, respectively. Impact of SpA on work productivity and activity impairment during and out-side of work was measured with the Work Productivity and Activity Impairment Questionnaire (WPAI: Spondyloarthritis). Results A total of 72 patients were enrolled, with a median age of 39 years (28.3–46), 65.3% men, and 54.4% working patients. Median scores of activity impairment outside of work, and work productivity loss were 50% (40–70), and 50% (40–60), respectively. Median absenteeism and presenteeism scores were 0% (IQR 0–7), and 100% (IQR 86.5–100), respectively. Regarding work-related outcomes: activity impairment was positively correlated with CSI and PCS; presenteeism was significantly associated with male sex ( p = 0.009); and work productivity loss was positively associated with anxiety, depression, and poor quality of life. Multivariate regression analysis identified predictive factors of work productivity loss: male sex, poor quality of life, and prolonged morning stiffness. Conclusions Assessment of the impact of pain catastrophizing and central sensitization on work-related outcomes in patients with SpA is important to understand the burden of illness and to identify early those in need of interventions in clinical practice.

Background: Precision in catheter guidance is essential for the success of vascular surgeries, yet current methods often need more accuracy due to the complex anatomy and dynamics of blood vessels. Methods: This study evaluates the efficacy of advanced reinforcement learning (RL) techniques to enhance catheter navigation. We compare different RL approaches within simulated vascular environments, focusing on their success rates, operational efficiency, and adaptability to varied clinical scenarios. Results: Advanced reinforcement learning techniques display exceptional performance, yielding high success rates and improved precision in catheter guidance. Integrating specific enhancements has notably increased learning speeds and strengthened operational robustness. Conclusion: The study indicates that reinforcement learning could significantly improve the precision and safety of catheter navigation in vascular surgery. By adopting these techniques, medical practices could see more accurate and less invasive procedures, enhancing patient outcomes. Future research should aim to refine these algorithms for wider clinical use and integration.

This study focuses on the potential of treated avocado seed to remove azoic organic dyes (basic yellow 28 and tartrazine). The treated avocado seed was characterized, and batch adsorption studies were carried out to evaluate the effects of several removal dye parameters (contact time, ionic strength, initial concentration, adsorbent dose, and temperature). The adsorption kinetics of the dyes examined showed that the adsorption mechanism on the two selected catalysts followed pseudo-second-order kinetics (R2 > 0.999). The adsorption process of each dye was reported to fit using five non-linear regressions. Freundlich and Temkin adsorption isotherms described well the adsorption of basic yellow 28, and Freundlich adsorption isotherms described well the adsorption of tartrazine on the Treated Avocado Seed. The results suggested that the maximum amount adsorbed was 49.30 mg/g for basic yellow 28 and 38.43 mg/g for tartrazine and a high removal rate of 89.93% for BY 28 and 93.22% for tartrazine and that a chemical, spontaneous and endothermic process of adsorption occurred. Boyd’s expression demonstrated a mechanism of film diffusion for adsorption. Based on the findings, we suggest the application of activated avocado seeds for the removal of azoic dyes in aqueous solutions.

Introduction Nowadays children and adolescents are exposed to cyber victimization.This modern form of aggressive behavior has a negative impact on the psychological of victims,self esteem, and social interaction Objectives To investigate the relation between cybervictimization and depression in tunisian preadolescents and adolescents Methods The Arabic validated version of the “cyberbullying assessment instrument” was distributed through social media groups of preadolescent and adolescents in Tunisia.The participants were also invited to answer items about social and demographic characteristics.The participation was voluntary,without confidential data. Results Fifty four preadolescent and adolescent aged between 9 and 16 years old have participated. The average age was 12.4 years old. 64% of participants were girls.More than 80% of children have their own smartphone and a personal count on social media.Among those respondents,12 (22.2%) reported being cyberbullied at least once in the year.the children most likely to be bullied were girl aged between 9 and 12 years old with a poor socioeconomic level.low self esteem, depressive symptoms, anxiety symptoms are associated with cyber victimization. Conclusions The level of cyber victimization among preadolescents and adolescents is underestimated. Psychiatric disorder associated to this phenomena have to be considered in order to develop strategies and intervention to reduce the cyberbullying among vulnerable population. Disclosure of Interest None Declared

Introduction The vaccination of children and adolescents against covid 19 is an ongoing debate. While in some countries the program of vaccination of children under 12 years old is already implemented, in others the balance of risk and benefits is a dilemma. Parents’ perception and decision about covid vaccination is an important parameter to consider. Objectives The ain of this study is to evaluate the parents’ attitude about childhood vaccination against Covid 19 in Tunisia. Methods The “vaccine hesitancy scale (VHS) adopted from WHO’s Strategic Advisory Group of Immunization” with 8 items translated in tunisian dialect and an additional ten survey idem about the Characteristics of parents and their vaccination status against Covid 19. The survey is distributed on social media groups of parents of tunisian children and adolescents. Results Thirty parents have answered the survey.More than 80% of the participants were female with an average age of 38 years old.Among 30 participants 24 were vaccinated against covid 19 at least for once, but only one of them 10% decided to vaccinate their children against covid 19,while 3% are indecisive about the subject.Although 97 % of the children and adolescents have already been vaccinated completely according to the national vaccination program. The most common reasons for the refusal were.Parents consider that routine childhood vaccines are safe, necessary and useful more than covid vaccine. Some parents reported that their children have been infected by the virus so they have doubts about the usefulness of the vaccination. Conclusions A year after the pandemic, covid 19 contamination and vaccination against the virus are still an issue. With the emergence of new variants, the decline in protective measures, vaccination against covid is in the process of integrating routine programs. But the lack of information on the effectiveness of the vaccine and the adverse effects are a source of hesitation and refusal for parents. a large-scale national study is necessary before. Disclosure of Interest None Declared

Highlights Patients with rheumatoid arthritis have higher rate of comorbidity which may impair their quality of life and affects disease outcomes. Rheumatic Disease Comorbidity Index (RDCI) is an excellent tool to predict extra-articular manifestations and signs of poor prognosis such as erosions, coxitis, and atlanto-axial dislocation. An early screening and an adequate management of comorbidities may result in better disease outcomes.

Aicha Ben Tekaya,1,2 Lilia Nacef,1,2 Mehdi Bellil,2,3 Olfa Saidane,1,2 Leila Rouached,1,2 Selma Bouden,1,2 Rawdha Tekaya,1,2 Ines Mahmoud,1,2 Leila Abdelmoula1,2 1Rheumatology Department, Charles Nicolle Hospital, Tunis, Tunisia; 2Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia; 3Orthopedic Department, Charles Nicolle Hospital, Tunis, TunisiaCorrespondence: Aicha Ben Tekaya, Rheumatology Department, Charles Nicolle Hospital, Tunis, Tunisia, Tel +216 97850485, Email aicha.bentekaya@fmt.utm.tnBackground: Calcium-pyrophosphate-dihydrate-disease (CPPD) is a crystal-induced arthropathy. The lumbar-spinal involvement is rare and often under-diagnosed. This study aimed to report the case of a lumbar spine CPPD involvement and to perform a systematic review of clinical, imaging features of lumbar involvement in CPPD patients, and treatments that have been implemented.Methods: This systematic review was conducted in accordance with the Preferred-Reporting-Items-for-Systematic-Reviews and Meta-Analyses (PRISMA) guidelines.Results: One hundred and sixty-seven articles met the search criteria using electronic databases searches. We retained 28 articles (20 case reports, 2 case series, 1 family survey, 4 retrospective studies, and 1 prospective study) involving a total of 62 patients. The age ranged between 39 and 89 years old. Among patients with lumbar spine CPPD, 32 were women. The duration of symptoms varied between one day and 8 years. The affection has been discovered during back pain in most cases. In 5 studies, the diagnosis was made on histological specimens of patients operated on for another pathology. X-ray showed calcifications in 2 cases. CT-scan detected calcium deposit in 7 cases. MRI showed lesions going from the increased signal of the disk, to calcified or not-cystic lesion of the facet joints, an intramedullary mass mimicking a schwannoma. Histological examination established the diagnosis of CPPD in 21 patients in all studies. Medical treatment included NSAIDs, Colchicine, Interleukin-1-receptor-antagonist, and antibiotics. Surgery was performed on 13 patients and allowed to establish the histological diagnosis.Conclusion: In the case of inflammatory back pain in elderly subjects, without an infectious gateway, diagnosis of CPPD should be considered, especially for patients with a history of spinal surgery or degenerative radiography changes. CT scan is more sensitive than conventional radiographs. The discovertebral biopsy is the Gold-Standard and should be performed whenever the diagnosis was uncertain. Treatment includes the medical and surgical components.Keywords: chondrocalcinosis, calcium pyrophosphate dihydrate disease, spine, radiculopathy, sciatica

BackgroundThe cognitive impairments exhibited by people with ASD, threaten the development of social skills that are essential for establishing and maintaining harmonious social relationships. Cognitive remediation and social skills training are now considered as crucial therapeutic approaches in the management of these disorders. Several programs have already been validated and have shown improvements in social skills or cognitive performance. However, the effects of these training methods seem to be difficult to generalize to other everyday life. The aim of our study is to alleviate cognitive and social deficiencies by using a socio-cognitive framework to adapt the Neuropsychological Educational Approach to Remediation (NEAR) method for adolescents with ASD.Methods/designAdolescents meeting the DSM-5 criteria for ASD, older than 13 years, and following a regular school curriculum will be recruited from clinical population at the Child and Adolescent Psychiatry in Razi University Hospital-Manouba- Tunisia. Our study is an open and non-randomized controlled trial including 30 patients: NEAR group / control group. The NEAR method combines computerized cognitive exercises and bridging groups inspired from cognitive behavioral therapy. NEAR group will be divided into three groups of five patients each. The duration of the sessions will vary according to the capacities of the participants and the exchanges between them (about 60–120 min). In our study, bridging groups will be amended by adding other tasks including planning role plays and scenarios of problematic social situations in autism, taking into account cultural particularities in order to promote social skills. Computerized exercises will be enriched by adding other tasks aiming to improve the recognition and expression of facial emotions by using digital videos and photographs expressing the six basic emotions. The duration of the program will be about 6 months. All selected patients will have an assessment of cognitive function: social cognition, neurocognition and pragmatic skills, social skills, self-esteem and global functioning at baseline, 1 week after the end of the NEAR program and 6 months later.ConclusionThis adaptive program is a promising socio-cognitive intervention that create new perspectives for adolescents with autism spectrum disorder.

Introduction The department of child psychiatry in Razi Hospital is the unique psychiatric unit in Northern Tunisia offering full-time hospitalization for minors with mental health disorders. Objectives The aim of our study was to explore the clinical and therapeutic characteristics in compulsory admissions of minors in the department of child psychiatry in Razi hospital between 2011 and 2019. Methods We conducted a retrospective study of medical records of inpatients admitted to the hospitalization unit of the child psychiatry department in Razi Hospital in Tunisia between 2011 and 2019. Results Over the nine years, the total number of compulsory admissions was 74 inpatients, aged from 11 to 16 years old. The number of compulsory admissions increased from 03 in 2011 to 22 in 2019. Most of the inpatients were boys (sex ration=1.46). The mean age was 14, 1 year old. Heteroagressiveness was the reason for admission in half of the cases followed by risk behaviors (30.1%) and suicidal behaviors (18.6%). The diagnosis of conduct disorder was found in 33.3% of the cases followed by a normal psychiatric examination in 11.8% of the cases. Mood disorders were found in 9.8% of the cases. Parental psychoeducation (100%), individual psychotherapy (91%) and family therapy (88,2%) were the treatment of choice for the inpatients. The prevalence of psychiatric medication was 45.1%. The most important forms of medication used were neuroleptics (42.3% of medicated patients) and mood stabilizers (30.7%). Child protection delegates were involved in 86,4% of the cases for social intervention. Conclusions Minors admitted in an involuntary mode to psychiatric unit have their own specifities in terms of clinical and therapeutic characteristics. More theoretical and empirical research is needed regarding the involuntary admission of minors. Disclosure of Interest None Declared

Introduction Admissions in a child psychiatry unit can be voluntary or unvoluntary in some cases when the patient meets specific criteria. Objectives The aim of our study was to assess the frequency and trend over time of admissions of minors in the child psychiatry department in Razi Hospital between 2011 and 2019, and to examine the psychiatric diagnoses in involuntary admissions of minors. Methods We conducted a retrospective study of medical records of inpatients admitted to the hospitalization unit of the child psychiatry department in Razi Hospital in Tunisia between 2011 and 2019. Results Over the nine years, the total number of hospitalizations was 924. There is a slight female predominance over the total number of hospitalizations (sex ratio = 0.85). There was no consistent and significant change in the number of hospitalizations between 2011 and 2019. A growing increase in the number of compulsory hospitalizations was noted. From 2011 to 2019, the number of compulsory admissions increased from 03 in 2011 to 22 in 2019. Regarding compulsory hospitalizations, admission requests came from child protection delegates, public prosecutors or family judges. Conduct disorder was found in 33.3% of the cases followed by a normal psychiatric examination in 11.8% of the cases. Mood disorders were found in 9.8% of the cases. Conclusions Our study shows the explosion in the number of compulsory hospitalizations despite a relatively stable total number of hospitalizations. More comprehensive guidance for legal authorities is needed regarding the compulsory admission of minors. Disclosure of Interest None Declared

Parabolic Trough Collectors (PTCs) are the most mature, reliable and widespread among Concentrated Solar Power (CSP) technologies for electricity generation. The conventional power plants relying on PTCs use synthetic oil as Heat Transfer Fluid (HTF) which has limited life span, has limited operation temperature, is expensive and harmful to the environment. In the present research work, a new perspective has been developed to directly generate steam in the collectors, eliminating the need for HTF in the solar field and avoiding auxiliary heat exchangers. A mini hybrid Direct Steam Generation PTC power plant having a boiler as a backup that can be operated with biogas or natural gas is installed at Ecole Nationale d'Ingénieurs de Tunis (ENIT) within the framework of REELCOOP project (Renewable ELectricity COOPeration). The description, commissioning and operation of the solar plant are presented in this paper. The plant is designed and tested under real-life operating conditions in the south Mediterranean region. The feasibility of the DSG process in horizontal parabolic trough collectors has been confirmed and an important know how has been acquired regarding the operation of DSG solar plant. The main instructions for the operation of the solar plant have been presented including start-up and shutdown procedures of the plant, as well as the safety measures to be considered.The development of this plant is aimed to address the challenge of coupling intermittent solar radiation and the presence of a two-phase fluid in the absorber tubes. An important know how has been acquired regarding the operation of DSG solar plants in solar only mode and in hybrid mode which allowed to balance strengths and weaknesses of solar and biogas/natural gas technologies. By combining both systems, we have tackled the problem of the controllability of the energy supply while exploiting as much as possible renewable sources.

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease, which is associated with an increased risk of cardiovascular disease (CVD). Metabolic syndrome (MetS) is a set of factors that increase the risk of CVD, and recent studies suggested an increased prevalence of MetS in RA more than in general population. Aim: The aim of this study is to determine the prevalence of MetS in patients with RA and to evaluate its association with the disease activity and inflammation parameters. Then, to evaluate other cardiovascular risk factor and HeartSCORE Eular 2015 and its relation with the MetS. Methods: It is a cross-sectional study of 103 RA patients assessing the prevalence of the MetS in RA patients. MetS was defined according to the National Cholesterol Education Program/Adult Treatment Panel III guidelines. RA disease activity was assessed with CDAI, SDAI and DAS28 scores. Independent risk factors for MetS in RA patients were identified by logistic regression. Results: The mean age was 53 ± 10 years. The sex ratio (Male/female) was 0.3. About half of patients (45%) had moderate disease activity with a mean DAS28 CRP score of 3.9±1.38. Prevalence of MetS was 38.8% in RA patients. MetS was associated with higher age (P=0.03), late onset disease age (P=0.01), family history of CVD (P=0.016), current use of corticoid (P=0.01) and menopause status (P=0.006). However disease activity, inflammation or treatment were not associated with MetS. Conclusions: MetS in RA patients was not associated with inflammation and disease activity.