Does mindfulness reduce perceived stress in healthcare professionals?

BACKGROUND: Healthcare professionals (HCPs) are exposed to multiple psychosocial risks that may lead to high levels of stress and low levels of life satisfaction and well-being. Mindfulness, defined as the awareness that arises by intentionally paying attention in the present moment and in a non-judgmental way, seems to be a moderator in the causal association between life stressors and well-being. AIMS: The aim of the present study was to test the model of relationships between self-reported mindfulness, perceived stress, well-being index and life satisfaction in a sample of Tunisian HCPs. METHODS: We performed a correlational cross-sectional study on a sample of HCPs at Hedi Chaker University Hospital, Tunisia. We used validated self-reporting instruments: the Mindful Attention Awareness Scale (MAAS), the Perceived Stress Scale (PSS), the World Health Organisation Well-Being Index (WHO-5) and the Satisfaction with Life Scale (SWLS). For data analysis, the SPSS version 23 program was used. RESULTS: Participants (n=297) included staff nurses (49.2%), medical technicians (19.2%) and doctors (31.6%). The overall model revealed that reduced perceived stress (ß=-0.30, P<0.000) and high levels of well-being (ß=0.13, P=0.03) were associated with mindfulness, explaining 14% of the variance. Individually, perceived stress significantly predicted mindfulness explaining 13% of the variance. CONCLUSION: The study explores a variety of elements that can support the development of mindfulness interventions for stress prevention, staff well-being, and improvement of services as a whole.

Workaholism in engineers: Prevalence and associated factors.

INTRODUCTION: Workaholism is an emerging form of behavioural addiction encountered in the workplace. The present study aims to assess the prevalence and the associated factors of this phenomenon in engineers. METHODS: A cross sectional survey was conducted for two months by means of an online questionnaire of engineers practising in Tunisia. The evaluation of workaholism was based on the WART questionnaire (Work Addiction Risk Test). RESULTS: A total of 107 engineers have answered the questionnaire. The mean age of participants was 29.2±4.4 years. Computer engineers represented 32.7% of our sample. Most of engineers worked more than 8hours per day (45.8%) and less than 6 days per week (63.6%). A high risk of workaholism was noted in 42.1% of cases. Statistical analysis showed that workaholism was not associated with socio-demographic characteristics. However, it was associated with smoking cigarettes, psychotropic drug consumption and poly-addiction and inversely associated with the presence of a leisure activity. With regard to occupational factors, workaholism was associated with agronomic engineering, working more than 8hours per day, working the whole week and a job satisfaction score under 5/10. CONCLUSION: Workaholism interested a significant proportion of this sample, and several professional factors could increase the likelihood of adopting this behaviour. The intervention of occupational doctors seems important in order to raise awareness about this form of addiction and to identify its early signs among employees.

Influence des facteurs épidémio-cliniques dans le résultat fonctionnel de la septoplastie: étude de 250 cas / Epidemiological and clinical predictive factors of success in septoplasty: Study of 250 patients

to describe the epidemiological and clinical aspects, to evaluate the surgical result and to identify the prognostic factors for the success of septoplasty. Methods: It was a retrospective study including 250 patients operated on for a septoplasty collected over a 6-yearperiod. The evaluation of our results was made using 2 tools: NOSE scale and the visual satisfaction scale. Results: In our series, there was a male predominance with a sex ratio of 1.4. The mean age of the patients was 32.7 years. The medical history was dominated by allergic rhinitis in 38.4% of cases. Nasal trauma was noted in 45.2% of cases. A subjective quantification of respiratory discomfort by the NOSE score made it possible to divide them into 3 groups:Group 1: Severe ON: 65.2% of cases; Group 2: Moderate ON: 31.6% of cases; Group 3: Mild ON: 3.2% of cases. Our analytical study of the epidemiological and clinical factors that may influence the functional results showed that: Severe or moderate overall discomfort, severe ON (NOSE scale> 50) or moderate (NOSE scale between 26 and 50), DS classified zone I, II, III according to the Cottle classification, a quasi-obstructive deviation were considered as a predictor of the success of septoplasty. Conclusion: Several factors can influence the results of a septoplasty that must be considered before any surgical indication.

Smell disorders evolution after chronic rhinosinusitis with polyps surgery

: The effects of chronic rhino sinusitis with polyps (CRSWP) surgery on smell symptoms have not been sufficiently studied. The aim of this study was to evaluate the impact of CRSWP surgery on smell symptoms over short and long-term follow-up and to identify the factors that might influence their evolution. Patients and methods: This was a retrospective study about 184 patients operated endoscopically for CRSWP. In post operative period, long-term local steroids were prescribed systematically. The sense of smell was evaluated preand post-operatively according to a subjective score (1: good smell, 2: hyposmia, 3: anosmia). Some factors, related to the patient, the CRSWP and the treatment, were tested in order to identify predictors of smell outcome after surgery.. Results: Before surgery, the anosmia and the hyposmia were noted in 90.8% and in 8.7% of cases, respectively. At six months after surgery, the improvement of olfactory score was significant: 84% of patient had the score 1 compared with 0.5% preoperatively (p < 0.0001). This improvement was maintained during the 2 first years and decreased significantly at 3 years, although an average delay of polyps recurrence was 23.4 months. Among the factors studied in our series, only the observance of postoperative corticosteroids was retained as a predictor of smell recovery after surgery (p = 0,011). Conclusion: CRSWP surgery can significantly improve the smell sense, especially during the two first years. This effect can be sustainable if good post operative compliance for local corticosteroid are achieved

Facteurs pronostiques des carcinomes épidermoïdes non métastatiques du larynx

Etudier les facteurs influençant le pronostic des carcinomes épidermoïdes du larynx. Méthodes: Etude rétrospective analytique menée sur 100 patients présentant un carcinome épidermoïde primitif du larynx, durant une période de 24 ans (1992­2015). Résultats: La survie globale à 1 an, à 3 ans et à 5 ans a été respectivement de 99 %, de 77 % et de 63 %. La survie sans maladie à 1 an, à 3 ans et à 5 ans a été respectivement de 88 %, de 76 % et de 63 %. L'étude univariée de la survie globale et la survie sans maladie a montré un impact péjoratif de l'atteinte ganglionnaire histologique, de l'engainement péri-nerveux et des limites chirurgicales tumorales (facteurs histo-pronostiques). Dans l'étude multivariée, seuls le stade T, le stade N, l'atteinte sous-glottique, l'atteinte du cartilage thyroïde et le délai de la radiothérapie postopératoire ont présenté un impact significatif sur la survie sans maladie. Aucun facteur n'a présenté d'impact significatif sur la survie globale, en analyse multivariée. L'étude statistique de la récidive n'a montré aucun facteur prédictif. Conclusion: Le stade tumoral et les facteurs histo-pronostiques sont les 2 facteurs pronostiques majeurs. Dans la littérature, Les principaux facteurs prédictifs de récidive sont: le stade tumoral, les limites chirurgicales tumorales et l'extension extra-nodale. Dans notre étude, aucun facteur prédictif n'a été trouvé.

Smell disorders evolution after chronic rhinosinusitis with polyps surgery

The effects of chronic rhino sinusitis with polyps (CRSWP) surgery on smell symptoms have not been sufficiently studied. The aim of this study was to evaluate the impact of CRSWP surgery on smell symptoms over short and long-term follow-up and to identify the factors that might influence their evolution. Patients and methods: This was a retrospective study about 184 patients operated endoscopically for CRSWP. In post operative period, long-term local steroids were prescribed systematically. The sense of smell was evaluated preand post-operatively according to a subjective score (1: good smell, 2: hyposmia, 3: anosmia). Some factors, related to the patient, the CRSWP and the treatment, were tested in order to identify predictors of smell outcome after surgery.. Results: Before surgery, the anosmia and the hyposmia were noted in 90.8% and in 8.7% of cases, respectively. At six months after surgery, the improvement of olfactory score was significant: 84% of patient had the score 1 compared with 0.5% preoperatively (p < 0.0001). This improvement was maintained during the 2 first years and decreased significantly at 3 years, although an average delay of polyps recurrence was 23.4 months. Among the factors studied in our series, only the observance of postoperative corticosteroids was retained as a predictor of smell recovery after surgery (p = 0,011). Conclusion: CRSWP surgery can significantly improve the smell sense, especially during the two first years. This effect can be sustainable if good post operative compliance for local corticosteroid are achieved.

Facteurs pronostiques des carcinomes épidermoïdes non métastatiques du larynx / Prognostic factors in laryngeal non-metastatic squamous cell carcinomas

But: Etudier les facteurs influençant le pronostic des carcinomes épidermoïdes du larynx. Méthodes: Etude rétrospective analytique menée sur 100 patients présentant un carcinome épidermoïde primitif du larynx, durant une période de 24 ans (1992­2015). Résultats: La survie globale à 1 an, à 3 ans et à 5 ans a été respectivement de 99 %, de 77 % et de 63 %. La survie sans maladie à 1 an, à 3 ans et à 5 ans a été respectivement de 88 %, de 76 % et de 63 %. L'étude univariée de la survie globale et la survie sans maladie a montré un impact péjoratif de l'atteinte ganglionnaire histologique, de l'engainement péri-nerveux et des limites chirurgicales tumorales (facteurs histo-pronostiques). Dans l'étude multivariée, seuls le stade T, le stade N, l'atteinte sous-glottique, l'atteinte du cartilage thyroïde et le délai de la radiothérapie postopératoire ont présenté un impact significatif sur la survie sans maladie. Aucun facteur n'a présenté d'impact significatif sur la survie globale, en analyse multivariée. L'étude statistique de la récidive n'a montré aucun facteur prédictif. Conclusion: Le stade tumoral et les facteurs histo-pronostiques sont les 2 facteurs pronostiques majeurs. Dans la littérature, Les principaux facteurs prédictifs de récidive sont: le stade tumoral, les limites chirurgicales tumorales et l'extension extra-nodale. Dans notre étude, aucun facteur prédictif n'a été trouvé.

[Orbital cellulitis in children: Report of 60 cases]. / Les cellulites orbitaires chez l'enfant : à propos de 60 cas.

The goal of this study was to describe the epidemiological, etiological, clinical and therapeutic features and clinical course of orbital cellulitis in children, and to assess the risk factors for retroseptal involvement. METHODS: This was a retrospective study including 60 children (67 eyes) diagnosed with orbital cellulitis. Two groups were defined according to the clinical form: pre- or retroseptal. RESULTS: We studied 29 cases (34 eyes) of preseptal cellulitis and 31 cases (33 eyes) of retroseptal cellulitis. The mean age was 4 years. The male: female ratio was 1.3. The prescription of anti-inflammatory drugs and antibiotics prior to hospitalization was noted in respectively four and 10 patients. Eyelid edema was the principal sign (100% of cases); exophthalmia was noted in 19 eyes, ptosis in 27 eyes and chemosis in 10 eyes. Oculomotor disorders were present in 4 eyes. The mean C-reactive protein level was 53.15±27mg/l in preseptal cellulitis and 92.09±21mg/l in the retro-septal cases. Orbital computed tomography was performed in 31 patients and MRI in 5 patients. The pathway of entry of the orbital infection was primarily from the sinuses (23 cases). All of our patients had received broad spectrum intravenous antibiotic therapy. Three children had a cavernous sinus thrombosis and had been treated with anticoagulant therapy. Surgical drainage was performed in five patients. The course was favorable and without sequelae for all the patients. Two independent risk factors for retroseptal involvement were identified: the prescription of anti-inflammatory drugs prior to hospitalization, and sinus involvement. CONCLUSION: Orbital cellulitis in children is a serious infection and requires close collaboration between the ophthalmologist, otolaryngologist, and pediatrician in order to be diagnosed and treated early so as to improve the prognosis for vision and life.

L'actinomycose en ORL : à propos de 7 cas

Objectif :L'actinomycose est une infection rare due à une bactérie anaérobie à Gram positif saprophyte des cavités naturelles de l'homme. Le but de ce travail est d'illustrer les difficultés diagnostiques de cette pathologie et de montrer l'importance de l'examen anatomopathologique dans ce cadre.Matériel et méthodes :Il s'agit d'une étude rétrospective de 7 cas d'actinomycose colligés entre les années 1998 et 2015.Résultats :L'étude a intéressé 4 femmes et 3 hommes d'âge moyen de 42 ans (16 à 70 ans). Tous les patients n'avaient pas d'antécédents odontogéniques ni traumatiques. Les localisations étaient nasopharyngées dans 4 cas et sub-mandibulaires dans 3 cas. La symptomatologie était peu spécifique. Une rhinorrhée purulente était notée dans 3 cas, une obstruction nasale bilatérale dans 2 cas, une haleine fétide dans 1 cas et une anosmie dans 1 cas. Le motif de consultation était une tuméfaction submandibulaire dans 3 cas. L'échographie et le scanner n'ont pas aidé au diagnostic positif d'actinomycose. L'examen bactériologique était négatif dans tous les cas. Le diagnostic préliminaire d'actinomycose n'a été évoqué par notre équipe dans aucun cas. Le diagnostic était confirmé en postopératoire par l'examen anatomopathologique d'un prélèvement biopsique dans tous les cas. Il avait mis en évidence des grains actinomycosiques. L'évolution était dans tous les cas favorable après un traitement à base de pénicilline G associé à la chirurgie.Conclusion :L'actinomycose peut prendre des aspects trompeurs prêtant à confusion avec des affections tumorales ou infectieuses à pyogènes. Aucune imagerie ne peut fournir des informations spécifiques pour le diagnostic. Les résultats négatifs des examens bactériologiques doivent être interprétés avec prudence. L'examen anatomopathologique est d'un grand apport pour poser le diagnostic

Highly contrasted responses of Mediterranean octocorals to climate change along a depth gradient.

Climate change has a strong impact on marine ecosystems, including temperate species. Analysing the diversity of thermotolerance levels within species along with their genetic structure enables a better understanding of their potential response to climate change. We performed this integrative study on the Mediterranean octocoral Eunicella cavolini, with samples from different depths and by means of a common garden experiment. This species does not host photosynthetic Symbiodinium, enabling us to focus on the cnidarian response. We compared the thermotolerance of individuals from 20 m and 40 m depths from the same site and with replicates from the same colony. On the basis of an innovative statistical analysis of necrosis kinetics and risk, we demonstrated the occurrence of a very different response between depths at this local scale, with lower thermotolerance of deep individuals. Strongly thermotolerant individuals were observed at 20 m with necrosis appearing at higher temperatures than observed in situ. On the basis of nine microsatellite loci, we showed that these marked thermotolerance differences occur within a single population. This suggests the importance of acclimatization processes in adaptation to these different depths. In addition, differences between replicates demonstrated the occurrence of a variability of response between fragments from the same colony with the possibility of an interaction with a tank effect. Our results provide a basis for studying adaptation and acclimatization in Mediterranean octocorals in a heterogeneous environment.

[Predictive factors for recurrence after surgery of nasal polyposis].

Introduction: Endoscopic sinus surgery has become the treatment of choice in the surgical management of patients with nasal polyposis. The aim of our study is to identify the role of some epidemiological, clinical and therapeutic factors in recurrence after surgery of nasal polyposis. Materials and methods: We conducted a retrospective study over a period of 11 years (between 2000 and 2010) including 184 patients operated for nasal polyposis after failure of prolonged medical treatment. We evaluated the impact of epidemiological and clinical factors (age, sex, asthma, Widal disease, allergy and stage of nasal polyposis at the time of surgery) and treatment (surgical technique, observance of postoperative topical steroids ) on postoperative recurrence. Results: Nasal poly­posis recurred in 26.6% of patients after an average period of 23 months. Widal disease, asthma and bad observance of the intranasal steroid therapy were significantly associated with postoperative recurrence in the univariate analysis. In multi­variate analysis the bad observance of the intranasal steroid therapy was the only factor significantly associated with recurren­ce. Conclusion: Postoperative steroids prescribed routi­nely in our practice can effectively prevent recurrence after endonasal surgery and this result was found in both uni­variate and multivariate analysis.

Acute chest syndrome after laparoscopic splenectomy in children with sickle cell disease: operative time dependent?

BACKGROUND: Laparoscopic splenectomy remains a technically demanding procedure. On patients with sickle cell disease (SCD), a post operative acute chest syndrome (ACS) can occur. The aim of the study was to look for predictive factors of post operative ACS. PATIENTS AND METHOD: It's a retrospective study on patients with SCD, who underwent a laparoscopic splenectomy in Robert Debré hospital, Paris, France, between March 2008 and December 2013. Diagnosis of ACS was done if the patient developed hypoxemia associated with fever above 38.5 °C and an infiltrate on chest x ray during the post operative course. Pre-, post- and operative factors were studied. Descriptive statistics were compared using the Mann-Whitney test or the exact Fisher test. A p inferior to 0.05 was considered as significant. RESULTS: 52 patients with SCD underwent a laparoscopic splenectomy. Twelve patients presented a post operative ACS (23%) (mean age at surgery 4 years old) while forty did not (mean age 5.25 years old). Neither previous episode of ACS nor any factors reflecting SCD severity were significant. The shorter the operative time was, the greater the risk of developing an ACS (p < 0.05). CONCLUSION: ACS is an important complication following laparoscopic splenectomy in patients with SCD. The immediate post operative management, in the absence of predictive factors for ACS, should be carefully followed in a high dependency unit at least for 48 h for all patients.

Occupational blood exposure among health care personnel and hospital trainees.

Blood and body fluid Exposure is a major occupational safety problems for health care workers. Therefor We conducted a descriptive and retrospective study to identify the characteristics of blood exposure accidents in health care settings which lasted five years (2005-2009) at the two university hospitals of Sfax. We have 593 blood exposure accidents in health care settings 152 (25.6%) health personnel and 441 (74.4%) trainees' doctors, nurses and health technicians. The mechanism of blood and body fluid exposure was accidental needle-stick injury in 78.9% of health staff, and 81% of trainees, accidental cut in 14.7% of health workers and 10.2% of trainees. The increasing severity of blood exposure accidents is linked to the lack of safe behavior against this risk.

Infrared characterization and electrochemical study of γ-methacryloxypropyltrimethoxysilane grafted in to surface of copper.

The formation of a protective layer of γ-methacryloxypropyltrimethoxysilane (γ-MPS) on copper is studied by diffuse reflectance infrared spectroscopy (DRIFT), gravimetric chemical (weight loss) and electrochemical (cyclic voltammetry and potentiodynamic polarization) measurements. By simple immersion in the silanic bath (90/5/5 v/v ethanol/water/silane), this agent immediately physisorbed on copper, but the protective effects are poor. Thiolate and siloxane band formation improve the performances of the silanic layer on the surface of copper especially after heat treatment process. Chemical and electrochemical measurements show that the protective action of heat treatment (HT/Cu-MPS) process is higher than that of aged process (aged/Cu-MPS).

Prise en charge des complications orbitaires et endocraniennes des sinusites bacteriennes aigues

Les complications orbitaires et endocraniennes des sinusites aigues infectieuses posent un probleme diagnostique et therapeutique Le but de notre travail est de proposer un algorithme de prise en charge de ces complications a travers une revue de litterature Les sinusites de la base du crane (frontal; sphenoidal et ethmoidal) sont les plus frequents en cause de complications endocraniennes. Les atteintes orbitaires sont le plus souvent consecutives a des sinusites ethmoidales chez l'enfant et fronto-maxillaires chez l'adulte. L'imagerie joue un role important dans le diagnostic precoce et precis de ces affections et pour guider le traitement. Le traitement du foyer sinusien est systematique aussi bien pour les complications orbitaires ou endocraniennes si l'indication chirurgicale est retenue. Les complications orbitaires sont traitees par des antibiotiques visant les bacteries en cause avec des indications chirurgicales selon la classification scannographique de Chandler. Le traitement est desormais plus conservateur notamment pour l'abces sous perioste. Pour les complications endocraniennes le traitement est base sur un traitement medical antibiotique. Le geste chirurgical serait fait en fonction du resultat de l'imagerie. Le pronostic est ameliore actuellement grace a la precocite du diagnostic; ainsi qu'aux progres rapportes dans le domaine de la chirurgie endonasale

Pectin extraction from lemon by-product with acidified date juice: rheological properties and microstructure of pure and mixed pectin gels.

The microstructure and the rheological properties of lemon-pectin mixtures were studied and compared to those of pure lemon (high methoxyl: HM) and date (low methoxyl: LM) pectins. Rheological properties were carried out in the presence of 30%, 45% and 60% sucrose, and increasing calcium concentrations (0-0.1%). The presence of date with lemon pectin led to a gel formation at 45% sucrose and in the presence of calcium, which was not the case for lemon pectin alone under the same conditions. It is suggested that lemon and date pectins interacted, leading to gel formations at different gelling temperatures, which were strongly dependent on degree of methylation. These results were confirmed by scanning electron microscopy, which revealed inhomogeneous gels where dense aggregated network and loose, open network areas were present. Addition of calcium to pectin mixture gels led to stronger and faster gel formation.

Epidemiology and risk factors for corneal graft rejection.

OBJECTIVE: The aim of this study was to evaluate the frequency and main risk factors for corneal graft rejection. PATIENTS AND METHODS: This retrospective study included 285 eyes in 256 patients who underwent a penetrating keratoplasty (KPT) from January 1995 to December 2004. The minimum follow-up was 12 months to evaluate graft evolution. Except for complications, the follow-up was weekly, then monthly for 6 months, and ultimately quarterly during the first year. Thereafter the follow-up was performed semi-annually. Patients were informed about the functional signs for which they have to urgently consult. RESULTS: Immunologic rejection of the corneal graft occurred in 128 KPT in 112 patients (rejection frequency = 41%). The identified main risk factors were new vascularization of the recipient cornea over 2 or more quadrants, corneal opacity due to an infectious origin, posttraumatic corneal opacity or congenital glaucoma, graft diameter >8 mm, and therapeutic KPT. CONCLUSIONS: Rejection of the corneal graft is the primary cause of KPT failure. One out of 2 graft failures was due to rejection. Two criteria are unanimously recognized as risk factors for rejection: neovascularization of recipient cornea and antecedents of corneal rejection. The rejection must be treated early to not endanger graft success, which imposes a close follow-up for grafted patients.

[Incidence, circumstances and consequences of falls in patients undergoing rehabilitation after a first stroke]. / Incidence, circonstances et conséquences des chutes chez les patients en rééducation après un premier accident vasculaire cérébral.

OBJECTIVES: To describe the incidence, circumstances, and consequences of falls in patients admitted in a rehabilitation ward after a stroke. METHODS: Prospective monitoring of falls over four years in a neurological rehabilitation unit. Use of fall registry. INCLUSION CRITERIA: age < 75 years, admission < 45 days after stroke onset, single stroke of 1 cerebral hemisphere (nonlacunar) or of the brain stem. Only falls due to loss of balance were considered; falls caused by a seizure or syncope were not considered. RESULTS: Of 217 consecutive patients with the inclusion criteria, 34 had fallen at least once (15.7%) and 10 twice (4.1%). Fall incidence, defined as the number of falls per patient per day was 2.2 per thousand. Half of the patients fell the first three weeks after admission. Most falls involved getting to or from the wheelchair or the bed; 1 patient had recovered minimal postural abilities at the gym but was not independent. Traumatic lesions were noted in 13 patients: they were minor in nine and severe in four, including three fractures. CONCLUSION: Falls due to loss of balance are a major problem in patients undergoing rehabilitation after a stroke. Getting to and from wheelchairs in the bedroom and bathroom by patients who are not allowed to do so play a key role in many falls. Prevention programs should consider this information.

[The functional and professional future of lower limb amputees with prosthesis]. / Facteurs liés à l'avenir fonctionnel et professionnel des amputés des membres inférieurs appareillés.

OBJECTIVE: The objective of our study is to evaluate the functional and professional becoming of lower limb amputated population with prosthesis. MATERIAL AND METHODS: Our study is retro-prospective. It interested lower limbs amputated patients who have beneficed during the period between 1982-1998 with prosthesis and have consulted in 1999. Data of our study were gathered by an hetero questionnaire. In order to evaluate the functional results of our patients, we have adopted the score established by the National association of doctors specialized in apparatus in France (ANMA). However, this score was little modified (in fact, we have eliminated the item "use of personalized vehicle for handicapped [VHP]", because no one of our patients possess it). The results were judged favourable: score 6-7; unfavourable: mean score between 3-5 and bad between 0-2. RESULTS: During the year of our survey, we have questioned 85 lower limb amputated patients with prosthesis: 67 were male and 18 were female. The mean age of our patients is 48 years (6 to 86 years). Our population was divided into: 31 traumatic amputated, 28 arteritics and 26 amputated of other etiologies (tumoral, infectious, congenital...). In 76 cases, the amputation is unilateral. It's located upper the knee in 51 cases. The evaluation of functional autonomy of our patients according to score adopted showed those results: 54.11% were favourable and 45.88% were unfavourable. In professional side, only 35 among our 60 active patients before amputation, have been able to resume, 12 have needed a professional rehabilitation. Among the 25 who hadn't taken up again their work, 15 have early retirement and ten are in unemployment. CONCLUSION: The amputation of lower limb constitute a major handicap which involves a functional and professional incapacity. We can reduce the risk of this incapacity by a good and appropriate rehabilitation.

[The isolated presence of anti-HBc antibodies: prevalence and interpretation based on the results of viral DNA research and anti-HBs antibodies measurement after vaccination]. / Présence isolée de l'anticorps anti-HBc: prévalence et interprétation à l'aide des résultats de recherche d l'ADN viral et du dosage des anticorps anti-HBs après vaccination.

In order to study the significance of the isolated presence of anti-HBc antibodies, we have looked for the 3 classic serological markers of the hepatitis B (HBs antigen, anti-HBs and anti-HBc antibodies) in 1,586 hospital agents who are to vaccinate in the framework of a campaign of systematic vaccination of the hospital personnel of university hospitals of Sfax for a period of 18 months. We identified subjects who presented isolated anti-HBc antibodies (33 individuals = 2.08%). In these subjects'serum, we performed a research of the DNA of hepatitis B virus (HBV) with a PCR hybridization technique using a couple of primers. One week after administration of a vaccine dose, we also measured anti-HBs antibodies in their sera. Among the tested 18 personnel with anti-HBc isolated antibodies, 11.1% had low rates of anti-HBs antibodies indicating that there is presumably primary antibody response and therefore a false positivity of anti-HBc antibodies in pre-vaccinal serology; while 11.1% others had higher rates of anti-HBs antibodies corresponding to a secondary antibody response, which witness a previous HBV immunisation. The research of the HBV-DNA was positive in 11.1% of tested personnel, testifying a presumably chronic portage of the virus with low rates of the HBs antigen undetectable with the serological techniques. For the remainder subjects with isolated anti-HBc antibodies (66.7%), the interpretation remains ambiguous.