[Prevalence and predictors of post-traumatic stress disorder in road traffic accidents]. / Prévalence et facteurs prédicteurs des troubles post-traumatiques chez les accidentés de la voie publique.

Introduction: trauma-related disorders following a road accident have both a health and an economic impact. Methods: we conducted a prospective study to determine the prevalence of these disorders, and to identify risk factors in subjects victims of road accidents and hospitalized in the Department of Orthopedic Surgery and Traumatology of the University Hospital Center of Sfax-Tunisia. Results: a total of sixty-ten subjects were included in this study. The prevalence of acute stress disorder was 37.1% and was associated with female sex, low educational level, previous medical and surgical history, passivity during the accident, severity of injuries and the presence of anxious and depressive symptoms. Post-traumatic stress disorder was observed in 40% of subjects and was associated with urban residential environment, passivity during the accident and anxious and depressive symptoms. Low scores for functional coping strategies and high scores for dysfunctional coping strategies were significantly associated with both disorders. Low educational level, urban residential environment, high levels of anxiety and depression, and denial coping strategy appear to be independent risk factors for acute stress and post-traumatic stress disorder. Conclusion: It is therefore important to determine the profile of people at greater risk of post-traumatic stress disorder, to enable early diagnosis in victims of road accidents.

Evaluation des Troubles Cognitifs Chez des Patients Tunisiens Atteints de Trouble Bipolaire en Rémission : Étude Cas-Témoins: Assessment of Cognitive Impairment in Tunisian Patients With Bipolar Disorder in Remission: A Case-Control Study.

OBJECTIVES: Our aims were to assess cognitive impairment in bipolar patients in remission compared with healthy controls, and to study its connection to clinical and therapeutic factors. METHODOLOGY: This was a case-control study of patients with bipolar disorder (BD) in remission and matched healthy controls. It was carried out at the Hédi Chaker University Hospital in Sfax, Tunisia. The Screen for Cognitive Impairment in Psychiatry (SCIP) scale was used to assess cognitive function in patients and controls. This scale comprises subtests for verbal learning with immediate (VLT-I) and delayed (VLT-D) recall, working memory (WMT), verbal fluency (VFT) and information processing speed (PST). RESULTS: We recruited 61 patients and 40 controls. Compared with controls, patients had significantly lower scores on the overall SCIP scale and on all SCIP subtests (p < 0.001 throughout) with moderate to high effects. In multivariate analysis, the presence of psychotic characteristics correlated with lower scores on the overall SCIP (p = 0.001), VLT-I (p = 0.001) and VLT-D (p = 0.007), WMT (p = 0.002) and PST (p = 0.008). Bipolar II correlated with lower LTV-I scores (p = 0.023). Age of onset and duration of the disorder were negatively correlated with PST scores (p < 10-3 and p = 0.007, respectively). Predominantly manic polarity correlated with lower VFT scores (p = 0.007). CONCLUSIONS: Our study showed that bipolar patients in remission presented significantly more marked cognitive impairments, affecting various cognitive domains, than the controls. These cognitive impairments appear to be linked to clinical and therapeutic factors that are themselves considered to be factors of poor prognosis in BD.

OBJECTIFS: Nos objectifs étaient d'évaluer les troubles cognitifs chez des patients bipolaires en rémission comparativement à des témoins sains et d'étudier leur rapport avec les facteurs cliniques et thérapeutiques. MÉTHODES: Il s'agissait d'une étude cas-témoins, menée auprès de patients atteints de trouble bipolaire (TBP) en rémission et de témoins sains appariés. Elle a été réalisée au centre hospitalo-universitaire (CHU) Hédi Chaker de Sfax (Tunisie). L'échelle the Screen for cognitive impairment in psychiatry (SCIP) a été utilisée pour l'évaluation des fonctions cognitives chez les patients et les témoins. Cette échelle se compose des sous-échelles d'apprentissage verbal avec rappel immédiat (VLT-I) et différé (VLT-D), de la mémoire de travail (WMT), de la fluence verbale (VFT) et de la vitesse de traitement de l'information (PST). RÉSULTATS: Nous avons recruté 61 patients et 40 témoins. Comparés aux témoins, les cas avaient des scores totaux du SCIP et de toutes les sous-échelles du SCIP significativement plus bas (p < 0,001 partout) avec des tailles d'effet modérées à élevées. Dans l'analyse multivariée, la présence de caractéristiques psychotiques était corrélée à l'abaissement des scores du SCIP total (p = 0,001), du VLT-I (p = 0,001) et VLT-D (p = 0,007), du WMT (p = 0,002), et du PST (p = 0,008). Le TBP de type 2 était corrélé à l'abaissement du score de VLT-I (p = 0,023). L'âge de début et la durée d'évolution du trouble étaient corrélés négativement au score PST (p < 10−3 et p = 0,007 respectivement). La polarité maniaque prédominante était corrélée à l'abaissement du score VFT (p = 0,007). CONCLUSIONS: Notre étude a montré que les patients bipolaires en rémission présentaient des troubles cognitifs touchant différents domaines cognitifs, significativement plus marqués que chez les témoins. Ces troubles cognitifs semblent être liés à des facteurs cliniques et thérapeutiques considérés eux-mêmes comme des facteurs de mauvais pronostic de la maladie bipolaire.

Prevalence and factors for anxiety and depression among secondary school teachers from Sfax city of Tunisia in times of the coronavirus disease 2019 pandemic: a cross-sectional study.

Introduction: teachers have to adapt during the coronavirus disease 2019 (COVID-19) pandemic to many changes that could potentially make them more vulnerable to psychological distress. We aimed to assess anxiety and depression in Tunisian secondary school teachers during the COVID-19 pandemic and to explore their associated factors. Methods: we conducted a cross-sectional survey concerning Tunisian secondary school teachers between May 1st, 2021, and June 30th, 2021, using an online survey platform via Google Forms. Participants were asked to fill in a form including two psychometric tests: the General Anxiety Disorder 7 (GAD-7) and the Patient Health Questionnaire 9 (PHQ-9). We performed both univariable and multivariable logistic regression analyses. Results: a total of 170 secondary school teachers were included, of whom 22.4% (n=38) were males and 77.6% (n=132) were females. The median age was 45.5 years (Q1=39, Q3=49). The overall anxiety prevalence was 34.7% (n=59) while it was 41.7% (n=71) for depression. In multivariable analysis, anxiety was strongly associated with sleep disturbances (aOR: 5.1; 95% CI: 1.80-14.45; p=0.002) and depression (aOR: 33.91; 95% CI: 12.32-93.33; p<0.001) while depression was strongly associated with dissatisfaction with working conditions (aOR: 3.99; 95% CI: 1.49-10.65; p=0.006), the irregular wearing of protective masks (aOR: 3.94; 95% CI: 1.33-11.66; p=0.013) and anxiety (aOR=51.63; 95% CI: 17.74-150.25; p<0.001). Conclusion: secondary school teachers in Tunisia are characterized by a high rate of anxiety and depressive disorders which are related to personal and professional factors on which we can act by supplying of educational institutions by protective masks, the implementation of programs for adjusting working conditions and the practice of non-pharmacological interventions for insomnia management.

Prévalence et facteurs prédicteurs des troubles post-traumatiques chez les accidentés de la voie publique / Prevalence and predictors of post-traumatic stress disorder in road traffic accidents

Introduction: les troubles post-traumatiques survenant à la suite d'un accident de la route ont un impact tant sanitaire qu'économique. Méthodes: notre étude prospective, vise à déterminer la prévalence de ces troubles, et de dégager leurs facteurs de risque auprès de sujets victimes d'accidents de la route et hospitalisés au service de chirurgie orthopédique et de traumatologie du Centre Hospitalo-Universitaire de Sfax-Tunisie. Résultats: soixante-dix sujets ont été inclus dans notre étude. La prévalence de l'état de stress aigu était de 37,1% et il a été associé au sexe féminin, au niveau scolaire bas, à la présence d'antécédents médicochirurgicaux, à la passivité au cours de l'accident, à la sévérité des lésions, et à la présence d'une symptomatologie anxieuse et dépressive. Le trouble stress post traumatique était constaté chez 40% des sujets et il a été associé au milieu de résidence urbain, à la passivité au cours de l'accident, et à la symptomatologie anxieuse et dépressive. Des scores faibles des stratégies de coping fonctionnelles et des scores élevés des stratégies de coping dysfonctionnelles ont été significativement associés à ces deux troubles. Le niveau scolaire bas, la résidence en milieu urbain, un niveau élevé d'anxiété et de dépression et la stratégie de coping de déni apparaissent comme des facteurs de risque indépendants de l'état de stress aigu et du trouble stress post traumatique. Conclusion: il s'avère ainsi important de déterminer un profil de personnes plus exposées aux troubles post-traumatique afin de permettre un dépistage précoce par les médecins avec lesquels les accidentés pourraient avoir des contacts dans les suites de leurs accidents.

ntroduction: Post-traumatic stress disorder following a road accident has both a health and an economic impact. Methods: we conducted a prospective study to determine the prevalence of this disorder, and to identify risk factors in subjects victims of road accidents and hospitalized in the Department of Orthopedic Surgery and Traumatology of the University Hospital Center of Sfax-Tunisia. Results: a total of sixty-ten subjects were included in this study. The prevalence of acute stress was 37.1% and was associated with female sex, low educational level, previous medical and surgical history, passivity during the accident, severity of injuries and the presence of anxious and depressive symptoms. Post-traumatic stress disorder was observed in 40% of subjects and was associated with urban residential environment, passivity during the accident and anxious and depressive symptoms. Low scores for functional coping strategies and high scores for dysfunctional coping strategies were significantly associated with both disorders. Low educational level, urban residential environment, high levels of anxiety and depression, and denial coping strategy appear to be independent risk factors for acute stress and post-traumatic stress disorder. Conclusion: It is therefore important to determine the profile of people at greater risk of post-traumatic stress disorder, to enable early diagnosis in victims of road accidents.

A survey to explore the psychological and professional impact of change imposed by COVID-19.

Aim: Staff of a department underwent a change following the COVID-19 pandemic. The objective of this study was to assess the psychological and professional impact of this change. Materials & methods: This is cross-sectional study, including all department staff conducted from 15 July 2021 to 15 August 2021. Results: All the staff concerned (n = 36) participated. Only 9.37% declared that they understood the change. The main problem encountered by participants was poor communication (86.2%). More than 75% among participants had a demotivation and 54.5% had resisted. The main cause of resistance was quality of organization (42.4%). Conclusion: Our study illustrates the difficulties encountered by actors involved in organizational change and the high risk of their resistance.

Criminal liability and epilepsy: a case report of a postictal attempted homicide from Tunisia.

OBJECTIVE: Patients with epilepsy who have been charged with a serious offense may be referred by the courts for forensic psychiatric examination. A detailed psychiatric and neurological examination is often necessary to assist the courts in making the right decision, as exemplified in the current case presentation. METHOD: The forensic case of a 30-year-old Tunisian male with temporal epilepsy who exhibited an inadequate response to the treatment is presented here. The patient attempted to kill his neighbor after a cluster of seizures, showing apparent postictal aggression. An antiepileptic treatment was introduced a few days after the person's detention and was followed by forensic psychiatric examination, but the latter was not done until three months afterwards. RESULTS: On forensic examination, the patient's thought processes were clear with no evidence of a thought disorder or psychosis. Both medical and psychiatric opinions stated that the attempted homicide was due to a postictal psychosis. The patient was transferred to a psychiatric facility for further management and was found not guilty by reason of insanity. CONCLUSION: This case illustrates the difficulties that experts may encounter in establishing criminal liability after aggressive behavior associated with epilepsy. It highlights shortcomings in Tunisian law (and promptness of forensic psychiatric examination) that should be addressed to ensure fairness of the legal process.

Methyl jasmonate induces oxidative/nitrosative stress and the accumulation of antioxidant metabolites in Phoenix dactylifera L.

OBJECTIVES: The present study aimed to explore the eliciting effects of increasing concentrations (50, 100, and 200 µM) of methyl jasmonate (MeJA). We cultivated actively proliferating buds of Phoenix dactylifera L. cv. Barhee in a temporary immersion system and we monitored the bioactive compound accumulation after 7 days of culture. METHODS: Total phenolic (TPC) and flavonoid (TFC) contents were determined by high-performance liquid chromatography (HPLC), Fourier-transform infrared (FTIR), and radical scavenging activity using DPPH and ABTS assays. We also explored the activity of phenylpropanoid pathway enzymes, namely phenylalanine ammonia-lyase (PAL), tyrosine ammonia-lyase (TAL) and polyphenol oxidase (PPO). RESULTS: Our results revealed that MeJA treatment induced oxidative stress, and at the same time increased the activity of related defense enzymes in a dose-dependent manner. Exogenous application of MeJA at 200 µM increased ROS (two fold), hydrogen peroxide (3.7 fold), nitric oxide (14 fold), MDA (6.3 fold), superoxide dismutase (5.9 fold), catalase (4.4 fold) and guaiacol peroxidase (3.87 fold). Furthermore, the results demonstrated that 200 µM MeJA treatment enhanced the activities of PAL (3.65 fold), TAL (4.35 fold), PPO (threefold) and increased TPC (twofold) and TFC (1.75 fold) contents in buds cultures higher than the control. HPLC analysis showed that buds cultures exposed to 200 µM MeJA accumulated maximum amount of catechin (11 fold), 4-hydroxybenzoic acid (1.48 fold), caffeic acid (2.5 fold) and p-coumaric acid (1.76 fold) and demonstrate antioxidant capacity with the lowest DPPH (114.5 µg ml-1) and ABTS (90.2 µg ml-1) IC50 values on day 7 of culture as compared to the control. The MeJA in the culture medium directly reduced cell viability in a dose dependent manner up to 35% with the highest concentration. CONCLUSION: The results of this study has revealed, for the first time, that MeJA offers a promising potential for the production of phenolic compound in Phoenix dactylifera L. buds.

Plasma oxysterols in drug-free patients with schizophrenia.

Evidence from clinical, genetic, and medical studies has shown the neuronal developmental disorder aspect of schizophrenia (SZ). Whereas oxysterols are vital factors in neurodevelopment, it is still unknown whether they are involved in the pathophysiology of SZ. The current study aims to explore the profile of oxysterols in plasma, ratio to total cholesterol (Tchol) and the association with clinical factors in patients with SZ. Forty men diagnosed with SZ and forty healthy controls matched for age and sex were included in the study. The ratios of cholestane-3ß,5α,6ß-triol, 27-hydroxycholesterol (27-OHC) and Cholestanol to Tchol increased in the schizophrenic group compared to controls. However, levels of 24S-hydroxycholesterol (24-OHC) were not significantly different between patients and controls. For the SZ patients, the plasma 24-OHC levels were positively correlated with the positive and negative syndrome total scores (PANSS) but negatively correlated with the Montreal Cognitive Assessment scores (MOCA). Moreover, the ratio Cholestanol to Tchol was negatively correlated with MOCA scores and positively correlated with PANSS general. The binary logistic regression analysis revealed that the ratio Cholestane-3ß,5α,6ß-triol/TChol could be considered as an independent risk factor for SZ. On the other hand, the receiver's operating characteristics analysis corresponding to potential biomarkers on SZ showed Areas Under the Curve (AUCs) of 82.1%; 69.7% and 77.6% for the ratio of Cholestane-3ß,5α,6ß-triol/TChol, 27-OHC/TChol and Cholestanol/TChol respectively. The relevance of Cholestane-3ß,5α,6ß-triol, 27-OHC and Cholestanol assays as biomarkers of this disease deserves further investigation.

Predictive value of oxidative stress biomarkers in drug-free patients with bipolar disorder.

OBJECTIVE: Oxidative stress is one of the primary etiological mechanisms of bipolar disorder (BD). METHODS: The present study was conducted over a period of 24 months on Tunisian on 34 drug­free male patients with BD (mean age: 34.5 years) and 101 age and gender matched controls (mean age: 34.20 years) were enrolled in the study. RESULTS: Plasma reduced glutathione (GSH) and total thiols levels were significantly decreased in patients compared to controls (respectively p < .001; p = .009). In addition, malondialdehyde (MDA), advanced oxidation protein products (AOPP), protein carbonyls (PC) and homocysteine (Hcys) concentrations and glutathione peroxidase (GSH-Px) activity were significantly increased in patients compared to controls (p = .002; p < .001; p = .001; p < .001 and p = .016, respectively). The binary logistic regression analysis revealed that MDA, AOPP and Hcys could be considered as independent risk factors for BD. When using CombiROC analysis, a remarkable increase in the area under the curve (AUC) with higher sensitivity (Se) and specificity (Sp) for MDA, AOPP, PC, GSH-Px and Hcys combined markers was observed. CONCLUSIONS: Overall, the identification of the predictive value of these five selected biomarkers related to oxidative stress in drug free patients should lead to a better identification of the etiological mechanism of BD.

[Assessment of psycho-trauma caused by the aggressions committed by patients with psychosis against their family caregivers: across-sectional survey]. / Évaluation du psycho-traumatisme lié aux agressions commises par les patients psychotiques sur leurs aidants familiaux: enquête transversale dans la région de Sfax, Tunisie.

INTRODUCTION: the management of patients with psychosis is associated with a risk of exposure to violence which can affect all the stakeholders, in particular the family entourage. Caregiving role generates violence and this can have a psychological impact on the caregivers. The purpose of this study is to evaluate the prevalence of aggressions perpetrated by patients with psychosis on their family caregivers as well as to assess the psychological and traumatic impact on family caregivers and to identify factors associated with it. METHODS: family caregivers of patient with psychosis were interviewed. We used two psychometric scales: the perception of prevalence of aggression scale (POPAS) and the impact of event scale-revised. RESULTS: the whole number of participants was 95. Three out of four caregivers (75.8%) reported having been subjected to moderate to severe aggressions by their sick relatives during the past year. Moderate to severe aggressions were significantly more common among older male caregivers, parents of patients with psychosis living in a different home. Fifty-four point seven percent of caregivers had possible posttraumatic stress disorder (PTSD) and the risk of developing this disorder increased significantly as the perceived severity of aggressions increased. The same sociodemographic profile of the caregivers, related to the severity of the aggressions, was associated with a risk of developing PTSD in the caregivers. CONCLUSION: the aggressions committed by patients with psychosis against their family caregivers appear to have a significant psychological and traumatic impact. Interventions targeting violence committed by patients with psychosis in their family environment should also be integrated into patient management.

Plasma oxysterols: Altered level of plasma 24-hydroxycholesterol in patients with bipolar disorder.

Cholesterol and its oxygenated metabolites, including oxysterols, are intensively investigated as potential players in the pathophysiology of brain disorders. Altered oxysterol levels have been described in patients with numerous neuropsychiatric disorders. Recent studies have shown that Bipolar disorder (BD) is associated with the disruption of cholesterol metabolism. The present study was aimed at investigating the profile of oxysterols in plasma, their ratio to total cholesterol and their association with clinical parameters in patients with BD. Thirty three men diagnosed with BD and forty healthy controls matched for age and sex were included in the study. Oxysterol levels were measured by isotope-dilution ultra-performance liquid chromatography-tandem mass spectrometry. Significantly higher levels were observed for cholestane-3ß,5α,6ß-triol, 27-hydroxycholesterol (27-OHC) and Cholestanol in patients with BD. The concentration of 24-hydroxycholesterol (24-OHC) was significantly lower in patients compared to controls. 24-OHC was also negatively correlated to MAS subscale score (r =-0.343; p = 0.049). In patients, 24-OHC was inversely correlated with age (r = -0.240; p = 0.045). Multivariate analysis found that BD acute decompensation was independently related to the rise in plasma 24-OHC (p = 0.002; OR = 0.966, 95 % CI [0.945 - 0.987]). However, the 24-OHC assay relevance as a biomarker of this disease deserves further investigation in other studies.

Predictive value of oxidative stress biomarkers in drug­free patients with schizophrenia and schizo-affective disorder.

Several studies have suggested that oxidative stress may represent one of the primary etiological mechanisms of schizophrenia (SZ) and schizoaffective disorder (SAD) which can be targeted by therapeutic intervention. The present study was conducted over a period of 24 months, between June 2016 and June 2018. All enrolled subjects were Tunisian, forty five drug­free male patients with SZ (mean age: 37.6 years), twenty one drug­free male patients with SAD (mean age: 28.8 years) and hundred and one age and gender matched controls (mean age: 34.2 years) were enrolled in the study. Plasma reduced glutathione (GSH) and Total thiols levels were significantly decreased in patients compared to controls (respectively p<0.001; p=0.050). In addition, malondialdehyde (MDA), advanced oxidation protein products (AOPP) and protein carbonyls (PC) concentrations and glutathione peroxidase (GSH-Px) activity were significantly increased in patients compared to controls (p<0.001; p<0.001; p<0.001 and p=0.003 respectively). The binary logistic regression analysis revealed that MDA, AOPP, PC and GSH-Px could be considered as independent risk factors for SZ and SAD. When using ROC analysis, a remarkable increase in the area under the curve (AUC) with higher sensitivity (Se) and specificity (Sp) for MDA, AOPP, PC and GSH-Px combined markers was observed. The present study indicated that the identification of the predictive value of this four-selected biomarkers related to oxidative stress in drug free patients should lead to a better identification of the etiological mechanism of SZ or SAD.

[Bipolar disorder vulnerability: The vitamin D path]. / Vulnérabilité au Trouble Bipolaire: La Piste de la Vitamine D.

OBJECTIVES: Bipolar disorder (BD) etiopathogenesis is still not well elucidated. It has recently been proven that 25-hydroxy vitamin D (25OHD) has an anti-inflammatory and neuroprotective role. Our objectives were to measure 25OHD plasma levels in patients with BD in acute decompensation and compare them with patients with schizophrenia (SCZ) or schizoaffective disorder (SAD) and with healthy controls. METHODS: This is a cross-sectional case-control study including male inpatients with a decompensation of their disease who were diagnosed with BD, SCZ or SAD according to DSM-5 criterias. The control group was constituted by unrelated healthy subjects, age-and-sex matched. RESULTS: The 25OHD level was significantly higher only in patients with BD compared to controls. 25OHD was also positively correlated to the PANSS scale (r = 0.282, p < 0.001) and to different MOCA scores (r = 0.326, p = 0.006) as well as aspects related to abstraction, attention and memory capacity. Multivariate analysis found that BD acute decompensation was independently related to the rise in plasma 25OHD (p = 0.012; OR =1.157, [1.032 -1.297]). CONCLUSION: Our study shows that BD acute decompensation is associated with the rise in plasma 25OHD synthesis. However, the vitamin D dosage relevance as a biomarker of this disease warrants a verification in other studies.

OBJECTIFS: L'étiopathogénie du trouble bipolaire (TB) demeure non encore bien élucidée. Récemment, il a été prouvé que la 25-hydroxy-vitamine D(25OHD) a un rôle anti-inflammatoire et neuroprotecteur. Nos objectifs étaient de mesurer les concentrations plasmatiques de la 25OHD chez des patients atteints de TB en décompensation aigue et de les comparer à celles de patients souffrant de schizophrénie (SCZ) ou de trouble schizo-affectif (TSA) et à celles de témoins sains. MÉTHODES: Il s'agissait d'une étude transversale de type cas-témoins qui a inclus des patients de sexe masculin hospitalisés pour une décompensation de leur maladie et chez qui les diagnostics de TB, SCZ, ou de TSA ont été retenus selon les critères du (DSM-5). Le groupe témoin a été constitué de sujets sains non apparentés, appariés selon l'age et le sexe. RÉSULTATS: La concentration de la 25OHD était significativement plus élevée uniquement chez les patients atteints de TB par rapport aux témoins. la 25OHD était aussi corrélée positivement à l'échelle PANSS (r = 0.282, p < 0.001) et aux différents scores de l'échelle MOCA (r = 0.326, p = 0.006) ainsi qu'aux dimensions concernant la capacité d'abstraction, d'attention et la mémoire . A l'analyse multivariée, la décompensation aigue du TB était liée de manière indépendante à l'élévation de la 25OHD plasmatique (p = 0.012; OR = 1.157, [1.032 -1.297]). CONCLUSION: Notre étude a montré que la décompensation aigue des TB était associée à une élévation de la synthèse de la 25OHD plasmatique. Toutefois, la pertinence du dosage de la vitamine D comme biomarqueur de cette maladie mérite d'être vérifiée par d'autres études.

The Management of Depressed Patients by the Tunisian General Practitioners: A Critical Trans-sectional Study.

Under-diagnosed and under-treated, depression has a pejorative prognosis. The general practitioners (GP) represent the most often consulted healthcare professionals by depressed patients. The aim was to describe how the Tunisian GPs manage the depressed patients and to note the difficulties they encounter in order to suggest corrective measures. A survey was conducted among 140 GPs in Sfax Governorate. The percentage of the GPs whose responses conformed to the scientific data in at least 67% of the items was 31.4%. Four factors were correlated to a good management of depression: age (p = 0.028), masculine gender (p = 0.016), long career (p = 0.034) and participation to continuous medical education sessions on depression (p = 0.01). Our study revealed inadequacies in the management of depression by the GPs. GPs were invited to sensitizing meetings. A training on depression was assured for the future internship supervisors by the commission of medicine of family in the Faculty of Medicine of Sfax.

Factors Affecting the Management of Somatic Comorbidity in Tunisian Patients with Schizophrenia.

Schizophrenia is often accompanied by somatic comorbidities, which make the management challenge of such patients more difficult. In this study, we proposed to identify the sociodemographic and clinical factors correlating with somatic comorbidities in patients with schizophrenia to facilitate screening and prevention. It was a retrospective descriptive study of 78 schizophrenia patients in clinical remission and followed in outpatient psychiatry. In addition to the acquired records, other data were provided by the clinical and biological examinations performed for each patient. The evaluation of the therapeutic adherence was carried out using the Drug Attitude Inventory (DAI).Seventy-six patients (97.4%) had somatic comorbidities with a mean of 3.83 (± 1.81). This number increased significantly in males, older patients, couples, urban patients, and those receiving a combination therapy. According to a multivariate study, the four predictors of an increased risk of comorbidities were age, use of psychoactive substances, waist size and therapeutic adherence.Our findings focus on somatic comorbidities risk in schizophrenia patients, requiring particular vigilance in their follow-up, and suggest some modifiable clinical factors that might be a preferred target for reducing or preventing the occurrence of such disorders.

Effect of the phosphogypsum amendment of saline and agricultural soils on growth, productivity and antioxidant enzyme activities of tomato (Solanum lycopersicum L.).

The objective of this study was to investigate the effects of phosphogypsum (PG) amendment on the physiochemical proprieties of saline and agricultural soils along with the growth, productivity and antioxidant enzyme activities of tomato plants ( Solanum lycopersicum L.) grown on the amended soils under controlled conditions. Obtained results showed that the amendment of saline soil (H) by PG induced a decrease in pH as well as in electrical conductivity. However, for the non saline soil (MC), there was a decrease in pH associated with an increase in electrical conductivity. For both soils, PG amendment led to an increase in Calcium (Ca) and sodium (Na), and a decrease in potassium (K) in plant tissues. Cadmium (Cd), Zinc (Zn) and Chromium (Cr) contents in different parts of plants increased in proportion with PG concentration in the soils. Apart from Cd, all the analyzed metals in tomato fruit were found to be below the recommended maximum allowable concentration (MAC). Our results showed that PG application, at doses not exceeding 20%, seems to be beneficial for growth, photosynthetic activity and productivity of tomato plants as well as in decreasing salinity of saline soils. In these conditions, the use of PG could be a promising project for the rehabilitation of marginalized and saline ecosystems with either ornamental or non-fruit species. For both soils, a significant accumulation of MDA in shoots was detected, reflecting cell membrane damage especially when the PG amendment reached 20%. Beyond 20 and 40% PG, tomato plants developed an enzymatic antioxidant defense system in response to salinity and heavy metal stress. However, at 80% PG, enzymes activities were significantly inhibited.

Quality of life in chronic hemodialysis patients:about 71 cases.

BACKGROUND: The chronic hemodialysis imposes various limitations on patients that may affect their quality of life. However, Tunisian studies on this matter remain scarce. AIMS: To assess the quality of life among hemodialysis patients and to identify the factors influencing their quality of life. METHODS: We performed a cross-sectional study which included 71 outpatients, during the month of January 2013, in the department of Nephrology at Hedi Chaker Sfax university hospital in Tunisia. We used the specific scale Kidney Disease Quality of Life Short-Form (KDQOL-SF™) to assess the patient's quality of life. This instrument combines the short form 36 health survey questionnaire (SF-36) and a specific module adapted to renal function. Regression analysis was used to adjust for confounding factors. RESULTS: The global average score, according to KDQOL-SF and the SF-36 were respectively 51.6 and 38.2. The QOL was impaired in 90% of the cases. The logistic regression identified six variables to be correlated with impaired QOL. These six factors in descending order of importance were:  lack of autonomy, a dialysis rhythm of thrice a week, an age over 60 years, a comorbid diabetes, low social economic level and living in rural areas. CONCLUSION: Our study highlights the high frequency of QOL impairment upon patients on hemodialysis underlining the interest of a systematic effort to assess the quality of life in those patients. It also shows the interest of acting upon modifiable factors correlated with the alteration of the quality of life. In this way, the professional integration of the patients should be favored as well as peritoneal dialysis.

A study of the relationship between eating disorders, stress level and selfesteem among medicine students.

BACKGROUND: Stress of the higher studies leads to various disorders, especially eating ones. Such disorders, once present, may influence body image and self-esteem of young students. AIM: to assess the prevalence of eating disorders among a group of Medicine students and to study its links with stress level and selfesteem. METHODS: It was a descriptive and analytic cross-sectional study, including 60 medicine students that were investigated during their revision for the final year exam. The participants had filled the perceived stress scale, the eating attitude test EAT-40 and The Rosenberg self-esteem scale. RESULTS: The eating disorders were found in 11% of the participants. Those had a low to a very low self-esteem in 40% of cases and a high perceived stress level in 36, 4% of cases. The eating disorders were significantlymore frequent among the female students (p=0, 03), the more sedentary (p=0,019), having a low to a very low self-esteem (p=0,032) and a high perceived stress level (p=0,001). CONCLUSION: Our study shows that the prevalence of eating disorders is not negligible among medicine students. Their presence depends on certain personal aspects (physical activities, body image satisfaction) and contextual aspects (period of exams, stress). If existing, they would affect negatively the self-esteem, especially of the girls. These various results pave the way for a multidisciplinary approach to students particularly vulnerable to eating disorders.