Non-classical human leukocyte antigen class I in Tunisian children with autism.

Autism spectrum disorders (ASD) are one of the most common childhood morbidities characterized by deficits in communication and social skills. Increasing evidence has suggested associations between immune genes located in the human leukocyte antigen (HLA) complex and etiology of autism. In this study, we investigated whether the non-classical class I HLA-G, -E, and -F polymorphisms are associated with genetic predisposition to autism in Tunisia. We aimed to find a correlation between HLA-G genotypes and soluble HLA-G (sHLA-G) levels. We have analyzed the HLA-G, -E, and -F genotypes of 15 autistic children and their parents. DNA typing of HLA class I genes was performed using PCR-SSP and PCR-RFLP methods. Also, we evaluated the serum levels of HLA-G (1 and 5) by a validated ELISA technique in autistic probands and their parents. No association was found between any polymorphism and autism in the study subjects. Additionally, we found no correlation between sHLA-G1 and sHLA-G5 and autism. Also, no significant difference in sHLA-G testing in parents and offspring was found. However, parents carrying [GG] genotype presented a higher sHLA-G levels than those carrying ([CC]+[GC]) genotypes (p = 0.037). From this preliminary study, we conclude that the investigated polymorphisms of HLA-G, -E, and -F genes did not lead to autism susceptibility in Tunisian children. However, the CGTIGA haplotype was found to be associated with the disease.

Impulsivity in adolescents with major depressive disorder: A comparative tunisian study.

BACKGROUND: The association between impulsivity and depressive disorders in adolescence has been little studied at the literature and in our country, yet impulsivity is a major risk factor for suicide. Thus we aimed on this study to evaluate impulsivity in 25 adolescents with Major Depressive Disorder MDD compared to a control sample and to analyze the correlations between impulsivity and clinical features of MDD. METHODS: Employing a matched case-control design, participants included 25 adolescents with MDD and 75 controls. We have administered the Barratt Impulsivity Scale BIS-11 for the two groups to evaluate impulsivity. Semi structured interviews according DSM 5 criteria were conducted for adolescents with MDD. The Child Depressive Inventory CDI was used to measure depressive symptoms in the control sample. RESULTS: Adolescents with MDD were more impulsive compared to controls according to the BIS-11 in its three domains: motor (24.96±6.26 against 20.6±4.84; p=0.000), attentional (20.88±5.03 against 16.64±3.2; p=0.000) and non planning (28.2±7.26 against 24.44±4.32; p=0.02). Impulsivity was not correlated with clinical features of MDD (suicide attempts, psychiatric comorbidities, antidepressant medication …). CONCLUSION: Adolescents with MDD seem to be more impulsive than control subjects regardless their clinical features. Whether it is a specific characteristic or a symptom among others of MDD, impulsivity predicts health-related behaviors and associated damage that need to be detected and prevented in time.

Prenatal, perinatal and postnatal factors associated with autism spectrum disorder / Fatores pré-natais, perinatais e pós-natais associados ao transtorno do espectrodo autismo

Abstract Objective: To identify prenatal, perinatal and postnatal risk factors in children with autism spectrum disorder (ASD) by comparing them to their siblings without autistic disorders. Method: The present study is cross sectional and comparative. It was conducted over a period of three months (July-September 2014). It included 101 children: 50 ASD's children diagnosed according to DSM-5 criteria and 51 unaffected siblings. The severity of ASD was assessed by the CARS. Results: Our study revealed a higher prevalence of prenatal, perinatal and postnatal factors in children with ASD in comparison with unaffected siblings. It showed also a significant association between perinatal and postnatal factors and ASD (respectively p = 0.03 and p = 0.042). In this group, perinatal factors were mainly as type of suffering acute fetal (26% of cases), long duration of delivery and prematurity (18% of cases for each factor), while postnatal factors were represented principally by respiratory infections (24%). As for parental factors, no correlation was found between advanced age of parents at the moment of the conception and ASD. Likewise, no correlation was observed between the severity of ASD and different factors. After logistic regression, the risk factors retained for autism in the final model were: male gender, prenatal urinary tract infection, acute fetal distress, difficult labor and respiratory infection. Conclusions: The present survey confirms the high prevalence of prenatal, perinatal and postnatal factors in children with ASD and suggests the intervention of some of these factors (acute fetal distress and difficult labor, among others), as determinant variables for the genesis of ASD.

Resumo Objetivo: Identificar fatores de risco pré-natal, perinatal e pós-natal em crianças com transtorno do espectro do autismo (TEA) ao compará-las com irmãos sem transtornos de autismo. Método: Estudo é transversal e comparativo. Foi conduzido em três meses (julho a setembro de 2014). Incluiu 101 crianças: 50 com TEA diagnosticadas de acordo com os critérios do DSM-5 e 51 irmãos não afetados. A gravidade do TEA foi avaliada pela Escala de Avaliação do Autismo na Infância (CARS). Resultados: Nosso estudo revelou uma prevalência maior de fatores pré-natais, perinatais e pós-natais em crianças com TEA em comparação com irmãos não afetados. Também mostrou uma associação significativa entre fatores perinatais e pós-natais e TEA (respectivamente p = 0,03 e p = 0,042). Nesse grupo, os fatores perinatais foram principalmente do tipo sofrimento fetal agudo (26% dos casos), longa duração do parto e prematuridade (18% dos casos em cada fator), ao passo que fatores pós-natais foram representados principalmente por infecções respiratórias (24%). No que diz respeito a fatores dos pais, nenhuma correlação foi encontrada entre a idade avançada dos pais no momento da concepção e o TEA. Da mesma forma, nenhuma correlação foi estabelecida entre a gravidade do TEA e fatores diferentes.Após regressão logística, os fatores de risco de autismo encontrados no modelo final foram: sexo masculino, infecção pré-natal do trato urinário, sofrimento fetal agudo, parto difícil e infecção respiratória. Conclusões: Esta pesquisa confirma a alta prevalência de fatores pré-natais, perinatais e pós-natais em crianças com TEA e sugere a intervenção de alguns desses fatores (sofrimento fetal agudo, parto difícil) como variáveis determinantes para a gênese do TEA.

Prenatal, perinatal and postnatal factors associated with autism spectrum disorder.

OBJECTIVE: To identify prenatal, perinatal and postnatal risk factors in children with autism spectrum disorder (ASD) by comparing them to their siblings without autistic disorders. METHOD: The present study is cross sectional and comparative. It was conducted over a period of three months (July-September 2014). It included 101 children: 50 ASD's children diagnosed according to DSM-5 criteria and 51 unaffected siblings. The severity of ASD was assessed by the CARS. RESULTS: Our study revealed a higher prevalence of prenatal, perinatal and postnatal factors in children with ASD in comparison with unaffected siblings. It showed also a significant association between perinatal and postnatal factors and ASD (respectively p=0.03 and p=0.042). In this group, perinatal factors were mainly as type of suffering acute fetal (26% of cases), long duration of delivery and prematurity (18% of cases for each factor), while postnatal factors were represented principally by respiratory infections (24%). As for parental factors, no correlation was found between advanced age of parents at the moment of the conception and ASD. Likewise, no correlation was observed between the severity of ASD and different factors. After logistic regression, the risk factors retained for autism in the final model were: male gender, prenatal urinary tract infection, acute fetal distress, difficult labor and respiratory infection. CONCLUSIONS: The present survey confirms the high prevalence of prenatal, perinatal and postnatal factors in children with ASD and suggests the intervention of some of these factors (acute fetal distress and difficult labor, among others), as determinant variables for the genesis of ASD.

[Attention Deficit Hyperactivity disorder at schools in Sfax-Tunisia]. / Caractéristiques épidémiologiques du trouble deficit de l'attention/hyperactivité en population scolaire dans la region de Sfax-Tunisie : Etude transversale.

BACKGROUND: Frequency, social impact, the negative effects of ADHD on personal development, make it a public health problem. Tunisian existing data confirm its frequency and severity in clinical population. The absence of data in student population has led us to develop this work.The objectives of our study were to study epidemiological profile of ADHD in school population. METHODS: The analysis involved a cross-sectional descriptive study conducted from April 2008 to October 2008 using a representative randomized multistage sample of schoolchildren between 6 and 12 years old. Measurement was performed in two stages first the parents and teachers of each children filled Conners questionnaire separately then students with the score in subscales inattention, hyperactivity with impulsivity higher than 70 were selected for psychiatric interview. Psychiatric interview was intended to confirm or refute the diagnosis of ADHD. The diagnoses were made according to DSM IV-TR. To study the possible associated factors with the disorder they were compared in children with ADHD and children without the disorder taken as controls. RESULTS: A total of 51 students out of 513 had ADHD. Prevalence was found to be 9,94%. For the study of factors associated with ADHD were found in males, neonatal hospitalization, psychiatric and family history of ADHD and the existence of a family dysfunctionment. CONCLUSION: Our prevalence is similar to the majority of those reported by studies conducted through the same methodology as ours. The etiology of ADHD is not unequivocal. The disorder appears to be multifactorial.

[Study of a Tunisian population of children with learning disorders]. / Etude d'une population tunisienne d'enfants en difficultés scolaires.

BACKGROUND: Learning disorders are increasingly a concern for Tunisians parents. These difficulties are divided into two groups: specific learning disabilities and non-specific learning disorders. AIM: Our work is part of a federated research project. Our aim is to determine the incidence, etiology and management of learning disorders in the region of Sfax. METHODS: We conducted a descriptive cross-sectional study on a population of 304 children assessed by their teachers as having academic difficulty. A multidisciplinary assessment including a neurological examination, an assessment of score of intelligence and language assessment has been performed for 209 children. RESULTS: Referring to our sample, learning disorders affect 21.3% of children in the region Sfax. The frequency of specific learning disorder is estimated at 10.3% (reading disorder 5.9%, dyscalculia 2.4%, reading disorder associated with dyscalculia 2%). Non-specific learning disorders were found in 11% of children. Etiologies in this group were dominated by mental retardation (2.1%), inappropriate education (2.3%). CONCLUSION: Our study revealed the high frequency of learning difficulties. It allows us to distinguish between specific learning disabilities and non specific learning disorders secondary to neurological or precarious socio-economic conditions. However, the profile and severity of specific learning disorders could not be studied due to the lack of standardized Arabic tests in Tunisia. In countries with a lack of professional and specialized unit care as in Tunisia, reading interventions in school should be proposed. Only children with remaining difficulties after this training will be sent to specialized professionals.

[Evolution of bipolar disorders in adolescents: 30 cases]. / Evolution des troubles bipolaires à l'adolescence : a propos de 30 cas.

BACKGROUND: Bipolar disorders in adolescence are of a great importance, partly because of the relapsing character of this disorder and its impact in terms of psychosocial adjustment. aim: To study the evolution of bipolar disorders in adolescents. METHODS: We conducted a descriptive and retrospective survey on 30 adolescents followed in the child and adolescent psychiatry department of Sfax for bipolar disorders diagnosed according to the DSM-IV TR criteria. RESULTS: The average number of the thymic episodes /year was 1.36±0.75. The average duration of the maniac episodes was 39. 75 day±24.79 and that of the depressive episodes was 78.75 days ± 43.73. The average duration of the inter critical intervals was 13.78 months ±11. 29. The complete remission was noted in 42.8% of the cases whereas the passage to chronicity was noticed in 3.6% of the cases. The family adaptation was satisfactory in 63.3% of the cases whereas the repercussion of the disorder on the school level was obvious. The social adaptation was non satisfactory in 53.3% of the cases. The suicide attempts were found in 10% of the cases. CONCLUSION: The findings of the present study justify an early identification of bipolar disorders in adolescents as well as the initiation of appropriate therapy. The early intervention will permit to reduce the duration and the severity of the episodes. It will also limit the deleterious impact on the life of the subject and decrease the risk of suicide, which seems to be raised when the subject is not or is badly treated.

[Comorbidity of depression with other psychiatric disorders in adolescents: about 77 cases]. / Comorbidité psychiatrique aux troubles dépressifs de l'adolescent: a propos de 77 cas.

BACKGROUND: In adolescents diagnosed with depressive disorders, psychiatric comorbidity is rather the rule than the exception. AIM: To find the prevalence of the association between depression in adolescents and other psychiatric disorders and second and to study the different mental disorders comorbid to depression. METHODS: We conducted a descriptive, retrospective and analytic survey carried on 77 subjects having been followed in the child psychiatry department of Sfax for depressive disorders diagnosed according to the DSM-IV TR criteria during a period of 9 years (from January 1st 1998 till 31st December 2006) RESULTS: 49.3% of the youths with depression had comorbid conditions: anxiety disorders in 23.37% of cases, disruptive disorders in 13% of cases (conduct disorders in 11.7 % of cases and oppositional defiant disorders in 1.3 % of cases), personality disorders in 13% of cases, substance abuse in 3.9% of cases and alimentary behavior disturbances in 2.6% of cases. A superimposed major depressive disorder in adolescents with dysthymia (« Double depression ¼) was present in 10.4 of cases. CONCLUSION: Throughout our study, we underline the frequency of the association between depression in teenagers and other mental disorders. The detection of this comorbidity has a great importance as it permits to understand the pathogenesis of depression in adolescents, to examine the implications of comorbidity for course and outcomes of this disorder and to elaborate the appropriate treatment.

[The psychological aspects of enuresis in children and teenagers]. / Les aspects psychologiques de l'enurésie chez l'enfant et l'adolescent.

A retrospective study over seven years shows a high frequency of underlying psychological dimensions to enuresis, mainly regressive and passive, but also aggressive and erotic. It is therefore important to understand the meaning of this symptom and to take into account, in the treatment, underlying affective disorders.

[The persistent crying of newborns and its treatment]. / Les cris persistants du nourrisson et leur prise en charge.

The persistent and unexplained crying of newborns, attributed to colic, is a frequent problem in paediatrics. Usually considered harmless, it can however have consequences on the baby's behaviour and emotional regulation. Moreover, mothers often misinterpret the crying. Faced with the maternal anxiety which is often associated, treatment must be multifocal.