[Tunisian version validation of quality life's questionnaire for chronic inflammatory disease of intestine]

The systematic evaluation of the quality of life is essential in the management of patients with chronic bowel disease [IBD] inflammatory diseases. Translate in Tunisian Arabic dialect the English version of "inflammatory bowel disease questionnaire" [UK- IBDQ] and validated by studying its psychometric validity, discriminative ability, reliability and sensitivity to change. 80 Tunisian patients with IBD completed the Tunisian version of the IBDQ [T- IBDQ], a visual analog scale, the SF- 36, the Harvey- Bradshaw index for Crohn's disease, and the index Simple clinical colitis activity for ulcerative colitis. The T- IBDQ included in the final version 5 fields. The internal validity of the items was satisfactory for all patients. TIBDQ was correlated with scores of SF- 36, visual analog scale scores and indices of activity of IBD. T- IBDQ distinguish between active disease and inactive disease. He was also sensitive to changes in disease activity. We validated in this work a Tunisian dialect Arabic version of the IBDQ: T- IBDQ. Its validity, discriminative ability, reliability and sensitivity to change were demonstrated

[Emotional disorders and inflammatory bowel disease]

The co-occurrence of emotional disorders [alexithymia, depression and anxiety] and inflammatory bowel disease [IBD] is reported in the literature. There are several possible explanations for this co morbidity. To evaluate the prevalence of alexithymia, anxiety and depression among patients with IBD and to compare them with a control group of healthy individuals and to discuss the relation between emotional disorders and IBD. We built a case - control study of 50 patients with IBD [ulcerative colitis [UC] and Crohn's disease [CD]]. The control group compounded 50 subjects without IBD and paired according sex, age, and school level. Alexithymia was assessed with the 20-item version of the Toronto Alexithymia Scale [TAS -20]. Participants completed the Hospital Anxiety and Depression Scale [HADS], which is a 14-item self-report scale providing separate subscale scores for anxiety [HADS-A] and depression [HADS-D]. Among the group of patients, the rates of anxiety, depression and alexithymia were, respectively, 52%, 44% and 54%. In this group, there were significantly more anxious, depressed, and alexithymic subjects than in the control group [p respectively, 0, 007, 0, 015 and 0, 002]. The anxiety and the depression were more frequent among patients who had active disease or symptoms than those in remission [p respectively, 0, 011 and 0, 035]. The comorbidity of emotional disorders and IBD seems to be frequent. Therefore, clinicians should look for those disorders in patients with IBD, by using specific scales. The adjunction of emotional disorder treatment, if needed, would allow optimizing the management of MICI

[Role of the psychosocial factors in blood pressure balance; Cross-sectional study including 100 ambulatory hypertensive patients]

Hypertension is a real public health problem. His pathogenesis involves a combination of several factors including environmental and psychosocial factors. We focus on the links between the blood pressure imbalance and some psychosocial factors in a population of ambulatory patients with hypertension. It was a cross-sectional study on 100 patients with hypertension followed up in Cardiology in Sfax [Tunisia]. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale [HADS]. Behavioral pattern was evaluated by a clinical interview, referring to the model of Friedman and Rosenman. We also collected socio-environmental, clinical, therapeutic and prognostic data. The most predictive factors of an unbalanced blood pressure were independently: personality type [A] or unspecified [p = 0002], high fat diet [p = 0026], poor drug adherence [p = 0038] and depression [p = 0015]. Several sociodemographic and lifestyle factors are interrelated and implicated in the blood pressure imbalance, suggesting the need of a hygienic behavior joining the international recommendations. We insist on the treatment of the anxious and depressive disease and the psychotherapeutic approach of some personality patterns in the management of hypertension

Cutaneous manifestations of inflammatory bowel disease

Cutaneous manifestations are relatively common complications of inflammatory bowel disease, although they vary widely. At the time of inflammatory bowel disease diagnosis, the mean incidence of these manifestations is around 10%. The aim of this article was to review some of the noteworthy skin disorders associated with inflammatory bowel disease. An electronic research of the medical literature was carried out on the web sites [PubMed], [ScienceDirect] and [Interscience Wiley]. The cutaneous manifestations associated with inflammatory bowel disease were divided into 3 groups based on the nature of the association: granulomatous cutaneous disease, reactive skin eruptions and other associated dermatoses. In this review, focus has been given on granulomatous cutaneous disease and reactive skin eruptions. Patients presenting with inflammatory bowel disease should be examined for cutaneous manifestations. For most of these cutaneous manifestations, the primary therapeutic target remains the bowel

[Large gastric diverticulum]

Gastric diverticula are infrequent anatomic abnormalities that are usually asymptomatic. We report a case of large gastric diverticulum and discuss disgnostic and therapeutic challenges. A 63-year-old man was admitted with vague epigastric discomfort. Physical examination and laboratory investigations were normal. Endoscopy revealed and erosive gastropathy and a pouch arising from the posterior aspect of the greater curve, 8 cm form the hiatus. Barium meal confirmed the presence of a 5 cm diameter diverticulum arising from the gastric fundus. Careful examination of the whole stomach at gastroscopy is recommended for not missing a diverticulum

Health- related quality of life in patients with inflammatory bowel disease: a tunisian study

Inflammatory bowel disease [IBD] impairs healthrelated quality of life [HRQOL]. To describe HRQOL in Tunisian patients with IBD and to compare it with a reference population. HRQOL was assessed with the Tunisian versions of the Medical Outcomes Study Short Form 36 [SF 36] and the Inflammatory Bowel Disease Questionnaire [IBDQ-32]. Sixty two IBD patients were included [23 CD, 39 UC]. The control group consisted of 62 healthy subjects. We have shown that HRQOL in Tunisian patients with IBD, measured with the SF-36, is lower than that of a Tunisian reference population without significant differences. Using the IBDQ-32, we found lower scores in women, in patients with CD, with material deprivation, and with active disease.Factors such as the experience of previous relapses or hospitalisations, disease duration, previous resective surgery, remission duration, maintenance therapy, marital status and smoking status do not have a significant impact on HRQOL in these patients. Most patients with established inflammatory bowel disease showed only minor impairment of their HRQOL. However, women and the patients suffering from active and Crohn's disease as well as the materially deprived patients are most at risk.. Better clinical care and psychological counseling for these more vulnerable groups may improve their quality of life

Giant lipoma of the transverse colon: a case report and review of the literature

Colonic lipomas are benign adipose tumors which are usually submucosal. Small lesions are asymptomatic and may be detected incidentally. Large lipomas can cause symptoms. We report a case of symptomatic giant colonic lipoma. A 67-year old woman was admitted to hospital with persistent abdominal pain, for which a barium enema showed a large polypoid mass occluding the lumen of the transverse colon. Colonoscopy revealed a tumor narrowing the bowel lumen of about 5 cm in diameter with a sessile appearance and ulcerated overlying mucosa. The possibility of colonic malignancy could not be precluded and an operative resection was performed. Pathological examination revealed a colonic lipoma. Twelve months after the surgery, the patient was free of symptoms. Awareness of the possibility of colonic lipomas is important for clinicians in terms of evaluation of therapeutic regimen

practice of traditional therapies in psychiatric environment: study about 100 cases

In all the communities, parallel forms of healing continue to be practised by the population in addition to the services offered by the [modern] psychiatry. The aim is to examine the current state of the traditional therapy in Tunisia and to try to deal with its scope, profile and determinants surveying the population of mentally ill patients. It is about a specific study carried out on 100 consecutive patients having consulted the service of psychiatry [C] of Hospital [RAZI] in Tunis. All the patients having an intellectual deficiency were excluded. We proceeded by a semi-open questionnaire in dialectical Arabic. 90 patients, composed of 38 women [42.2%] and 52 men [57.8%] at the age of 37.8 years in average, were kept in our study. 50% of our patients had recourse to the traditional therapy, 70% of whom before consulting a psychiatrist. This behaviour was not influenced by the age, the profession and the educational level. In 75% of the cases, it was chosen under the effect of the opinion of a member of the family. 1/3 of the patients having had consulted a traditional therapist have improved after his intervention. These are the patients who were convinced of the diagnosis identified by the traditional therapist. The therapeutic observance and the adherence to the modern psychiatry were not influenced by the recourse to the traditional therapy. At the end of this research, we conclude that in Tunisia the recourse to the traditional therapy still persists and continues to perform its function. It makes us think about the necessity to accept its place in the devices for treatment of the mentally ill patients and why not to collaborate with it

[Septic shock in a Tunisian intensive care unit: mortality and predictive factors. 100 cases]

This is a retrospective study, of 100 consecutive patients with septic shock hospitalized in the ICU of Mongi Slim Hospital La Marsa between January 1997 and December 2001. The state of shock was defined according to the criteria established by the American College of Chest physicians in conjunction with the Society of Critical Care Medicine during the consensus conference on sepsis. Our study shows that septic shock affect both sexes in the same way, that it increases with the age and with the existence of underlying diseases. The global mortality was 82%. According to our study o, septic shock mortality in creases with age and with the existence of an underling pathological condition such as high blood pressure. It, also increases with the cause of the septic shock. [Pleuro-pulmonary]