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.

Alexithymia impairs quality of life in irritable bowel syndrome.

Aim: Our objectives were to compare the frequency of alexithymia and the alteration of quality of life in irritable bowel syndrome (IBS) and to determine the factors associated with alexithymia and quality of life deterioration. Method: This is a comparative study which collected 80 IBS patients and 80 controls. Results: Quality of life was impaired in 75% of patients vs 37.5% (p < 0.0001). The prevalence of alexithymia was 50% in patients vs 1.2% (p < 0.0001). In multivariate analysis, an impaired quality of life was associated with alexithymia (p = 0.003). The factors associated with impaired quality of life were anxiety and alexithymia. Conclusion: Alexithymia was present in half of patients with IBS and its was associated with impaired quality of life.

Comparative study of the effect of oleuropein and hydroxytyrosol rich extracts on the reproductive toxicity induced by bisphenol A in male rats: biochemical, histopathological, and molecular analyses.

Bisphenol A, or BPA, goes into the composition of a large number of products including sunglasses, infant's feeding bottles, receipts, or food packaging. Nowadays, there is a growing evidence that BPA may be at the origin of several physiological malignancies. Oleuropein and hydroxytyrosol extracted from olive leaves are highly investigated for numerous health benefits. The present work investigates the potential protective proprieties of olive leaf extracts against BPA-induced testicular damage in Wistar rats. Thirty-two animals were randomly divided into 4 groups: control, BPA-treated (10 mg/kg), BPA and oleuropein rich extract (16 mg/kg) treatment, and the last group treated with BPA and hydroxytyrosol rich extract (16 mg/kg). Biochemical parameters and histological and molecular analyses were evaluated. Our data demonstrated that BPA treatment caused significant alteration in biochemical parameters, disorganization of germinal epithelium, an up-regulation of p53 and Bax, and a reduction of Bcl-2 protein levels. The ingestion of oleuropein- and hydroxytyrosol-rich extracts attenuated BPA-induced biochemical and histological changes. In fact, olive leaf extracts enhanced the enzymatic antioxidant system and the level of Bcl-2, and reduced the expression of p53 and Bax. Fairly, our findings propose that olive leaf extracts may compete with BPA-induced reprotoxicity in vivo.

A mouse ear skin model to study the dynamics of innate immune responses against the microsporidian Encephalitozoon cuniculi.

Microsporidia are obligate intracellular parasites related to fungi that cause severe infections in immunocompromised individuals. Encephalitozoon cuniculi is a microsporidian species capable of infecting mammals, including human and rodents. In response to microsporidian infection, innate immune system serves as the first line of defense and allows a partial clearance of the parasite via the innate immune cells, namely macrophages, neutrophils, dendritic cells, and Natural Killer cells. According to the literature, microsporidia bypass this response in vitro by modulating the response of macrophages. In order to study host-parasites interactions in vivo, we developed a model using the mouse ear pinna in combination with an intravital imaging approach. Fluorescent E. cuniculi spores were inoculated into the skin tissue to follow for the first time in real time in an in vivo model the recruitment dynamics of EGFP + phagocytic cells in response to the parasite. The results show that parasites induce an important inflammatory recruitment of phagocytes, with alterations of their motility properties (speed, displacement length, straightness). This cellular response persists in the injection zone, with spores detected inside the phagocytes up to 72 h post-infection. Immunostainings performed on ear tissue cryosections evoke the presence of developing infectious foci from 5 days post-infection, in favor of parasite proliferation in this tissue. Overall, the newly set up mice ear pinna model will increase our understanding of the immunobiology of microsporidia and in particular, to know how they can bypass and hijack the host immune system of an immunocompetent or immunosuppressed host.

A jojoba (Simmondsia chinensis) seed cake extracts express hepatoprotective activity against paracetamol-induced toxicity in rats.

This study aimed to investigate the hepatoprotective activity of jojoba seed cake extracts against an acute paracetamol (PC) intoxication. Two aqueous extracts from jojoba (Simmondsia chinensis) seed cake, a simmondsin-rich extract (WE), and a simmondsin-hydrolyzed extract (NE) using Viscozyme L enzyme have been prepared and characterized. After enzyme treatment, simmondsin content decreased from 33.0 % to 3.0 % and glucose content increased from 16.2 % to 27.3 % reflecting simmondsin hydrolysis. Both extracts were administered to different rat groups via gavage (0.6 g/kg b.w.) before PC treatment (2 g/kg b.w.) three times a week for 3 weeks. The PC intoxication altered the serum biomarkers, the oxidative status, and the Tumor necrosis factor alpha (TNF-α), Bax and Bcl-2 protein expressions of tested animals. In addition, the histological analysis of liver tissues proved significant injury and hepatocellular necrosis. WE and NE extract showed a relatively high in vitro radical scavenging (ORAC) and averting activities (HORAC) with a polyphenol content of 3.6 % and 2.9 %, respectively. Both extracts showed a powerful in vivo hepatoprotective activity against PC-induced toxicity by improving the hepatocellular antioxidant status and blocking proteins expression (TNF-α, Bax and Bcl-2), involved in inflammation and liver damage. However, the enzymatic treatment improved the hepatoprotective activity of NE despite its lower simmondsin content and lower in vitro antioxidant capacity. This enhancement could be linked to the synergetic effect between the antioxidant components and the new hydrolytic products as glucose, uronic acids, arabinose and simmondsin-aglycons. These results suggest that jojoba waste could be potentially valorized in developing hepatoprotective drugs.

Federated learning for COVID-19 screening from Chest X-ray images.

Today, the whole world is facing a great medical disaster that affects the health and lives of the people: the COVID-19 disease, colloquially known as the Corona virus. Deep learning is an effective means to assist radiologists to analyze the vast amount of chest X-ray images, which can potentially have a substantial role in streamlining and accelerating the diagnosis of COVID-19. Such techniques involve large datasets for training and all such data must be centralized in order to be processed. Due to medical data privacy regulations, it is often not possible to collect and share patient data in a centralized data server. In this work, we present a collaborative federated learning framework allowing multiple medical institutions screening COVID-19 from Chest X-ray images using deep learning without sharing patient data. We investigate several key properties and specificities of federated learning setting including the not independent and identically distributed (non-IID) and unbalanced data distributions that naturally arise. We experimentally demonstrate that the proposed federated learning framework provides competitive results to that of models trained by sharing data, considering two different model architectures. These findings would encourage medical institutions to adopt collaborative process and reap benefits of the rich private data in order to rapidly build a powerful model for COVID-19 screening.

[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.

Oleuropein and hydroxytyrosol rich extracts from olive leaves attenuate liver injury and lipid metabolism disturbance in bisphenol A-treated rats.

In the present study, we investigated the protective effects of oleuropein- and hydroxytyrosol-rich extracts obtained from olive leaves against bisphenol A (BPA)-induced hyperlipidemia and liver injury in male rats. For this purpose, four groups of male rats (8 per group) were used: control group (Control), rats treated with BPA, rats treated with both BPA and oleuropein (OLE-BPA), and rats treated with both BPA and hydroxytyrosol (HYT-BPA). After 60 days of treatment, the results obtained using the DXA technique showed that treatment with BPA (10 mg per kg b.w.) increased the body weight and adipose tissue mass in male rats. Moreover, plasma levels of triglycerides, total cholesterol, LDL-cholesterol, AST, ALT, LDH, and TNF-α increased. The immunohistochemical analysis revealed a significant increase in the expression of COX-2 and p53 and a decrease in the expression of Bcl-2 related to liver inflammation. Oral administration of oleuropein and hydroxytyrosol-rich extracts obtained from olive leaves at 16 mg kg-1 reduced both the body weight and adipose tissue mass. These extracts were able to ameliorate liver damage and improve the elevated levels of TG and liver enzymes of BPA-treated rats possibly through enhancing CAT and SOD activities. Western blot results revealed that administration of the abovementioned extracts decreased the protein expression of NF-κB and TNF-α through the p38 signaling pathway. Overall, the findings suggest that the olive leaf extracts possess hypolipidemic and hepatoprotective effects against BPA-induced metabolic disorders through enhancing the antioxidative defense system and regulating the important signaling pathway activities.

Oleuropein and hydroxytyrosol protect rats' pups against bisphenol A induced hypothyroidism.

Bisphenol A (BPA) can disturb the endocrine system and the organs that respond to endocrine signals in organisms, indirectly exposed during prenatal and/or early postnatal life. The present study was designed to assess the protective effect of phenolic compounds from olive leaves against BPA induced thyroid dysfunction and growth perturbation in young rats during lactation. The BPA disrupting effect on thyroid function was investigated by measuring changes in plasma levels of thyroid hormones. Free triiodothyronine (FT3) and thyroxine (FT4) were decreased in young rats breast-fed from mothers treated with bisphenol A. This effect was associated with an increase in the plasma level of thyroid-stimulating hormone (TSH). The histological and immunohistochemical study of the thyroid gland revealed a disturbance in morphological structure and thyroid cells function. Thyroid dysfunction led to a disruption in the skeletal bone growth of young rats. In fact, the infrared microspectroscopic analysis and histological examination of femoral bone showed significant changes in their histoarchitecture associated with a perturbation in the mechanism of bone tissue mineralization. The administration of oleuropein or hydroxytyrosol in BPA treated lactating mothers improved the thyroid cells function by enhancing thyroid hormone levels. Moreover, these phenolics increased the body growth characterized by an amelioration in the structure and the microstructure of femoral bone tissue. HPLC analysis of rats-breast milk indicated the presence of oleuropein and hydroxytyrosol, which could contribute to the protective effect against bisphenol A induced hypothyroidism in pups rats.

Is there a Place for Prebiotics in the Management of Neonatal Inguinal Hernia? A Preliminary Study.

The objective of this study was to assess the place of prebiotics in the management of neonatal inguinal hernia. Boys with a diagnosis of unilateral non-complicated inguinal hernia, aged less than 40 days, were prospectively followed from January 2012 to December 2014. Clinical and psychiatric data and outcomes were collected before and after prebiotics (Primalac AC) administration. Ninety-eight patients were included. There were 75 inguinal hernias and 23 inguino-scrotal hernias. Before prebiotics administration 72.2% of infants had abdominal distention and 98% had colic. After prebiotics, abdominal distention and colic regressed in 85.2% and 73.2% of patients, respectively. Hernias disappeared clinically in 66.3% of cases. The factors associated with the disappearance of hernias were the type of the hernia (p<0.001), colic (p<0.001), and abdominal distention (p<0.001). Prebiotics would be a new adjunct in the management of neonatal inguinal hernia. They decrease colic and abdominal distention, which seems helpful to prevent strangulation and probably get spontaneous resolution of small hernias.

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.

Evaluation of hypocholesterolemic effect of oleuropein in cholesterol-fed rats.

Oleuropein, which is the major compound of olive leaves, has been reported to exert several pharmacological properties, including anti-cancer, antidiabetic and anti-atherosclerotic activities. The objective of this study was to evaluate the effect of oleuropein on adiponectin level in high cholesterol diet (HCD) induced obesity in rat and the molecular mechanism underlying its activation. Our results showed that orally administered oleuropein (50 mg/kg) by gavage for 8 weeks decreased the body weight, adipose tissue mass and triglyceride and attenuated steatosis in liver. Moreover, the effect of oleuropein on adiponectin, an important hormone with fatty-acid oxidation properties, was evaluated and our data illustrated that oleuropein supplementation increased serum adiponectin concentration. The effects of oleuropein on protein expression related to lipogenic genes were investigated and our results showed that its administration significantly inhibited peroxisome proliferator-activated receptor γ (PPARγ), sterol regulatory element-binding protein-1c (SREBP-1c) and fatty-acid synthase (FAS). In addition, oleuropein stimulated the HCD-induced inhibition of AMP-activated protein kinase (AMPK) in epididymal adipose tissues. These results suggest that oleuropein exerts anti-obesity effects in HCD rats by activating AMPK and suppressing PPAR γ (Peroxisome proliferator-activated receptor γ) expression in adipose tissues. These data provide that oleuropein has important implications for preventing obesity.

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.

[Athletic performance, self-esteem and temperamental profile : Which relationship?]. / Le rendement sportif, l'estime de soi et le profit temperamental: Queslles relations?

BACKGROUND: Several authors emphasize the close relationship between self-esteem and athletic performance; such a relationship may raise the following question: by saying "strong" or "without any physical condition", is it a fair presentation of the individual's abilities or he reveals the most fundamental aspects of his personality, such as emotional temperament? OBJECTIVES: To evaluate self-esteem, physical self and temperamental profile in a group of sportsmen, and to look for a relationship between these variables and athletic performance. METHODS: We performed a cross-sectional, descriptive and analytic study in 80 young handball players of the "senior" category. We assessed self-esteem using the Rosenberg Self Esteem Scale, physical self-using the Physical Self-Inventory (PSI), and temperamental profile using the Temperament Evaluation of Memphis, Paris and San Diego Auto-questionnaire (TEMPS-A). Athletic performance was evaluated by the team coach by means of a score ranging from 1 to 10. RESULTS: High self-esteem was correlated to female gender (p=0.03), to an early start of physical activity (p<0.01), and certain dimensions of the physical self: perceived physical value (p=0.02), appearance (p<0.01), and the global score (p=0.01). Athletic performance was correlated to high self-esteem (p<0.01) and to two dimensions of the physical self: the global score (p=0.01) and the perceived physical value (p<0.01). Hyperthymic temperament was associated with high self-esteem (p=0.001). Good athletic performance was associated with hyperthymic (p<0.01) and cyclothymic (p<0.01) temperament. Low athletic performance was associated with depressive (p=0.04) and irritable (p=0.01) temperament. CONCLUSION: Our study shows the close relationship between selfesteem, temperamental profile and athletic performance. We suggest that the intervention of a psychiatrist or a psychologist aimed at improving sportsmen's' self-esteem might help to achieve better athletic performance. In this intervention, the individual temperamental profile should be taken into account.

[Postpartum depression: prevalence and risk factors. A prospective Study concerning 302 Tunisian parturients]. / La dépression du postpartum: prévalence et facteurs de risque Etude prospective concernant 302 parturientes tunisiens.

BACKGROUND: Depression is a common condition especially in the postpartum. It exposes mothers, newborns and couples for psychosocial complications. AIMS: They were to estimate the prevalence of the depression in postpartum in a population of 302 Tunisian parturients and to identify its associated factors. METHODS: Our study was prospective, in two stages: at the first week (T1), then between sixth and tenth week of the postpartum (T2). The study was conducted at CHU Hédi Chaker in Sfax, Tunisia. We used the Arabic version and validated the Edinburgh Postnatal Depression Scale (EPDS) for screening for postpartum depression. We used the scale MSSS. "Maternity Social Support Scale"to assess the social and family support and the Azrin scale to evaluate the satisfaction of the conjugal relationship. An epidemiologic questionnaire was used to collect the sociodemographic and clinical data. RESULTS: At T1, 302 women were examined. At T2, 139 were reexamined (46% of the initial population). In the first stage, the prevalence of the intense postpartum blues, according to EPDS, was 19,2%. In the second stage, the prevalence of the postnatal depression was 12, 9%. Factors associated with postpartum blues intense were the low socioeconomic status (p =0, 01), a lower educational level (p = 0,017), the poor marital relationship (p =0, 04), an insufficient social support (p 0,001), the difficulty to accept pregnancy (p =0,001), the presence of psychiatric the presence of psychiatric history (p =0,001), the prematurity (p =0,001) and an ill newborn birth (p =0,001). Factors associated with the post natal depression were the low socioeconomic status (p =0,01), the poor marital relationship (p =0,034), difficulty with pregnancy (p =0,001) and the presence of psychiatric history (p =0,001). CONCLUSION: Postpartum depressions are common. It seems to be the result of the interaction of several biological, psychological and social factors. This suggests the importance of screening for women having such risk factors to prevent the installation of this depression. This detection should be done early in postpartum or else in the later postnatal consultations. This allows an adequate treatment for the mothers, for the relationship mother-new born and later, for the psychological equilibrium of the child.