Diabetes Distress and Illness Perceptions in Tunisian Type 2 Diabetes Patients.

Purpose: Diabetes distress (DD) refers to the negative emotions and burden of living with diabetes. Illness perceptions are among the factors that can influence self-management and psychological distress in diabetics. This study aimed to determine the prevalence and the associated factors of DD in Tunisian patients with type 2 diabetes mellitus. We also studied the relationship between DD and illness perceptions in diabetics. Patients and Methods: This was a cross-sectional study conducted among individuals with type 2 diabetes, followed up at the outpatient endocrinology unit at the Hedi Chaker University Hospital, Tunisia. DD was assessed using the Diabetes Distress Scale (DDS-17). The Brief Illness Perception Questionnaire (Brief-IPQ) was used to assess diabetes illness perceptions. Multivariate logistic regression was used to determine independent factors associated with the presence of DD. Results: A total of 103 patients were recruited. The mean age was 59.31 (±10.83) years; 54.4% were female. In total, 70.9% had DD. Using regression analysis, we demonstrated that the illness perceptions of personal control, HbA1C, absence of comorbidities, lower age at diabetes diagnosis, and socioeconomic status were significantly associated with DD. Conclusion: This study sheds light on the high prevalence of DD among patients with type 2 diabetes in Tunisia. Illness perception-focused psychological intervention would be efficacious in reducing diabetes distress in patients with type 2 diabetes mellitus.

[Knowledge, attitudes and practice of medical students concerning sexual matters]. / Connaissances, attitudes et pratiques des étudiants en médecine en matière de sexualité.

Sexuality is a central aspect of being human throughout life. People with sexual problems commonly turn to their doctor, because he is regarded as competent and well informed. The purpose of our study was to assess the knowledge, attitudes and practice of medical students concerning sexual matters and to identify the main determinants of the lack of basic knowledge on this subject. We conducted a descriptive and analytical study of students in the Faculty of Medicine of Sfax (Tunisia). The questionnaire, completed individually and anonymously by each student, collected sociodemographic data, knowledge about sexuality as well as sources, student's attitude towards sexuality and sexual practices. The overall average score of sexology related questions was 11,05/20. Factors correlated with a medium high score of sexology related questions were: male sex (p=0.003), married status (p=0.012), high socioeconomic status (p=0.02), books as a source of the information (p=0.041) and sexual practices (p<0.001). Sexual practices were significantly more frequent among male students (p<0.001). There are gaps in knowledge about sexuality among medical students, at least in some of its aspects. A complete and uniform educational program about human sexuality, especially in its physiological aspects, can significantly improve the ability of future physicians to provide optimal patient care.

Anxiety and Problematic Internet Use in Tunisian students.

BACKGROUND: The timing of this study coincides with the growing rate of penetration of Internet service across the country.  However, it is predictable that any new technology may be associated with a variety of human responses, sometimes harmfull. The young students seem to be especially vulnerable. OBJECTIVE: The purposes of this study were to evaluate Problematic Internet Use among medical undergraduate students and to investigate for associated anxious symptoms. METHODS: We conducted a cross-sectional study on 120 students enrolled in undergraduate medical studies at the University of Medicine of Sfax- Tunisia. The self-administered Young's 8-item questionnaire was used in this survey. The state and trait anxiety inventory was administered to screen for anxiety symptoms. RESULTS: The results showed that 21.7% of the students have Problematic Internet Use (PIU).The rate of the PIU is greater in male students than infemale students (p=0.035). Anxiety trait was significantly associated in students with PIU compared to those without PIU (p=0.002). Anxiety state was significantly associated in students with PIU compared to those without PIU ( p = 0.003). CONCLUSION: Problematic Internet Use is frequent in our students population. Asking students about the characteristics of their Internet usage will help to determine the threats to which they might be exposed. Such association with other psychopathologic problems, especially anxiety, should be sought.

Mismatch Repair Deficiency in Endometrial Cancer: Immunohistochemistry Staining and Clinical Implications.

INTRODUCTION: DNA mismatch repair (MMR) deficiency is associated with increased risk of developing several types of cancer and is the most common cause of hereditary endometrial cancer. Identification of the microsatellite instability (MSI) phenotype in endometrial carcinoma is important given that such tumors are frequent. OBJECTIVE: The objective of this study was to assess the utility of immunohistochemistry (IHC), a simple and fast technique, in detecting MSI status in endometrial carcinoma and evaluate the correlation between the MSI phenotype and the various anatomo-clinical parameters. METHODS: IHC expression of 4 markers (MLH1, MSH2, PMS2, and MSH6) was studied. For all IHC markers, a combined score based on the intensity of nuclear labeling and the percentage of labeled cells was defined to establish a score. Correlation between MSI phenotype and different clinicopathologic parameters was evaluated using statistical analysis (software STATA and the Fisher exact test). RESULTS: The mean age of the patients was 58.6 years. Positive staining was highly extended (score 3) with 79% to 100% of marked cells. Less than 10% of positive tumor cells were seen in 3% of cases for MSH6 and PMS2. Abnormal MMR IHC was detected in 10 cases (22.22%). Seven tumors showed loss of MLH1/PMS2. The loss of MSH2/MSH6 was observed in 1 case. The loss of MLH1 or PMS2 was seen only in 2 cases. The number of MSI positive status was 10 cases (22.7%). Correlation between clinicopathologic parameters showed MMR deficiency was significantly associated with low-grade tumor and localized stage. There was no positive correlation between age, histologic subtype, or myometrium invasion. CONCLUSIONS: In summary, detection of DNA MMR deficiencies by IHC can effectively diagnose the MSI phenotype in endometrial carcinoma. Correlation between clinicopathologic parameters showed MMR deficiency was significantly associated with low-grade tumor and localized stage.

Valproic Acid and Hepatic Steatosis: A Possible Link? About a Case Report.

BACKGROUND: Valproic acid is a mood-stabilizing anticonvulsant. Hepatic injuries are among the occasionally observed adverse effects of this medication. CASE PRESENTATION: We present the case of a 47-year-old man who had bipolar disorder for ten years and treated with valproic acid. He demonstrated elevated serum aminotransferases and ultrasonography revealed that hepatomegaly was suggestive of hepatic steatosis. CONCLUSION: This case report stresses the importance of a complete drug history and the need for clinicians to be aware of the delayed onset of hepatic injuries.

Post-stroke emotional incontinence or bipolar disorder?

INTRODUCTION: Post-stroke emotional incontinence and bipolar disorder are two disorders that involve the dysfunction of brain structures responsible for emotional regulation. The objective of this work is to study the links between these disorders through a clinical case. CASE REPORT: We present the case of a 43-year-old man without previous psychiatric history who experienced emotional incontinence after cerebrovascular events. He reacted promptly to selective serotonin reuptake inhibitor treatment. However, he experienced his first episode of hypomania after 6 months of antidepressant therapy. Adjunctive therapy with valproic acid and low-dose paroxetine was eventually added, resulting in complete improvement of both emotional incontinence and hypomania after 4 additional months of treatment. CONCLUSION: The clinician should carefully explore any history of premorbid bipolar disorder, personality disorder characterized by mood instability, and family history of bipolar disorder.

Impulsivity in bipolar disorders in a Tunisian sample.

Impulsivity as a trait characteristic is increased in bipolar disorder and may be a core factor of the illness. The objectives of our work are to evaluate the level of impulsivity among patients with bipolar disorder and to study its relation with mood state, alcohol misuse, suicide attempts and other socio-demographic and clinical factors. We measured impulsivity in 60 subjects with bipolar disorder in relationship to socio-demographic and clinical variables. The subjects completed Data included socio-demographic details and clinical variables, the Barratt Impulsiveness Scale (BIS-11) in an Arabic version to assess impulsivity, The Mini International Neuropsychiatric Interview "MINI" version 05 to screen for alcohol abuse or dependence and mood graphic rate scale (MGRS) to evaluate mood state. Our results show that the mean score of BIS-11 was 71.5. Fifty-five per cent of the patients had a high level of impulsiveness. No differences were found relating to mood state. Impulsivity was related to Male gender, lower educational level, early age of onset, smoking, alcohol and drug misuse and prior suicide attempts. The treatment of patients with BD should consider to reduce impulsivity to improve morbidity.

The profile of drug users in Tunisia: Implications for prevention.

BACKGROUND: Despite cultural, religious, and legal constraints on Muslims against the consumption of drugs, usage and misuse do exist. Drug addiction in Tunisia is a wide-spread problem and is destroying the lives of many individuals and families. AIMS: To examine the socio-demographic characteristics of substance users and to identify the drugs commonly used. METHODS: In this cross-sectional study, all the patients admitted at the addiction treatment center ''Aide et Ecoute'' in the period from January 2014 to September 2014 formed the sample of the present study. RESULTS: Only two hundred males were found to get treatment in the addiction center for various addictions. Among them, 65.9% were not married and 59.5 % had involvement with criminal justice. The mean age was 33.32 years and the mean age for starting substance use was 17.30 years. Substance use was higher (90.6%) in less educated people (secondary or below) and in urban population (73.2%). The most common substance misused was Buprenorphine (34.8%). There was a significant relation between buprenorphine consumption and immigration p= 0.013. CONCLUSION: Our observations point towards the vulnerability of younger age and immigrated population towards substance use and hence, it is proposed preventive health policies in this regard.

Schizophrenia and Leigh syndrome, a simple comorbidity or the same etiopathogeny: about a case.

Leigh syndrome is a mitochondrial encephalomyopathy that occurs due to "cytochrome c oxidase deficiency". Few psychiatric disorders have been defined that are associated with Leigh syndrome. The objective of this work is to study relations between mitochondrial dysfunction and psychiatric disorders. It was a 20 year old male patient, who received Modopar, for severe extra pyramidal symptoms caused by Leigh syndrome. He developed, four months ago, acute psychotic symptoms such as audio-visual hallucinations, persecution and mystic delirium. The cerebral MRI has shown signal abnormalities in central grey nucleus. The EEG recording and blood test were normal. The hypothesis of drug induced psychiatric disorders (Modopar) was possible. The evolution under atypical antipsychotic was only partial. In this case, the cerebrospinal fluid and lactate levels mean that mitochondria were not an overall explanation for these psychiatric disorders but may at least play a partial role. Psychiatric disorders may just be acomorbidity.

The relationship between alopecia areata and alexithymia, anxiety and depression: a case-control study.

BACKGROUND: Alopecia areata (AA) is a skin disease characterized by the sudden appearance of areas of hair loss on the scalp and other hair-bearing areas, but its aesthetic repercussions can lead to profound changes in patient's psychological status and relationships. AIM: The goal was to investigate a possible relationship between AA and alexithymia as well as two other emotional dimensions, anxiety and depression. MATERIALS AND METHODS: Fifty patients with AA seen in the Department of Dermatology of Hedi Chaker University Hospital, Sfax were included in this study. Anxiety and depression were evaluated by Hospital Anxiety and Depression scale questionnaire, alexithymia was assessed by Toronto Alexithymia scale 20, and severity of AA was measured by Severity of Alopecia Tool. RESULTS: Patient's mean age was 32.92 years. 52% of patients were females. Depression and anxiety were detected respectively in 38% and 62% of patients. There was statistically significant difference between patients and control group in terms of depression (P = 0.047) and anxiety (P = 0.005). Forty-two percent of patients scored positive for alexithymia. No significant difference was found between patient and control groups (P = 0.683) in terms of alexithymia. Anxiety was responsible for 14.7% of variation in alexithymia (P = 0.047). CONCLUSIONS: Our study shows a high prevalence of anxiety and depressive symptoms in AA patients. Dermatologists should be aware of the psychological impact of AA, especially as current treatments have limited effectiveness.

Quality of life in alopecia areata: a sample of tunisian patients.

Background. Alopecia areata (AA) has a significant impact on the quality of life and social interaction of those suffering from it. Our aim was to assess the impact of AA on the quality of life. Methods. Fifty patients diagnosed with AA seen in the Department of Dermatology of Hedi Chaker University Hospital, between March 2010 and July 2010, were included. Quality of life was measured by SF 36; severity of AA was measured by SALT. Results. Eighty percent had patchy alopecia with less than 50% involvement, 12% had patchy alopecia with 50-99% involvement, and 8% had alopecia totalis. Compared with the general population, AA patients presented a significantly altered quality of life, found in the global score and in five subscores of the SF-36: mental health, role emotional, social functioning, vitality, and general health. Gender, age, marital status, and severity of alopecia areata had a significant influence on patients' quality of life. Conclusions. This study indicates that patients with AA experience a poor quality of life, which impacts their overall health. We suggest screening for psychiatric distress. Studies of interventions such as counseling, psychoeducation, and psychotherapeutic interventions to reduce the impact of the disease may be warranted.

Effects of nickel hyperaccumulation on physiological characteristics of Alyssum murale grown on metal contaminated waste amended soil.

A pot experiment was conducted to investigate the effect of nickel concentration on physiological characteristics of Alyssum murale when grown in a soil mixed with sewage sludge (at the rate of 2.8%). Two types of sludge were used: agricultural sewage sludge (S1) and industrial sewage sludge with an increasing nickel concentration (S2, S3, and S4). Results showed that Ni in shoots was higher than Ni in roots. A. murale is able to concentrate up to 12730 mg/kg Ni in leaves. The highest dry matter yield was observed with plants grown with agricultural sewage sludge. An addition of S2 and S3 increased shoot biomass. However, application of S4 reduced 40% shoot dry weight as compared to the control Ni treatment did not affect all chlorophyll fluorescence parameters. The F(v)/F(m) ratio was stable between Ni treatments. Photosynthesis rate (A) increased with agricultural sewage sludge, but remained stable with variable Ni rates from the industrial sludge. The chlorophyll content increased with S1, S2 and S3 but it remains constant with S4 when compared to the control Therefore, high nickel concentration did not affect the function of the photosynthetic machine of A. murale.