Validation of the Hamilton Depression Rating Scale (HDRS) in the Tunisian dialect.

OBJECTIVES: The Hamilton Depression Rating Scale (HDRS) is one of the most frequently used depression assessment scales. In Tunisia, psychiatrists commonly use this scale in a Tunisian dialect. However, to the best of our knowledge, this scale has never been validated in Tunisia. This study aims to investigate the reliability and the validity of the HDRS among Tunisian patients who have been hospitalised for a suicide attempt. A secondary objective is to describe the sociodemographic characteristics of the study population. STUDY DESIGN: This is a cross-sectional study performed in the emergency department. METHODS: Patients who were hospitalised for a suicide attempt were eligible for inclusion in this study. The Tunisian version of the HDRS was developed using a forward-backward translation procedure. Psychometric properties of the Tunisian version of the HDRS were tested, including (i) construct validity with a confirmatory one-factor analysis; (ii) internal validity with Pearson correlations and Cronbach alpha coefficients; and (iii) external validity by correlations with the Patient Health Quality-9 (PHQ-9) scale. We used the Receiver-Operating Characteristic (ROC) curve to analyse the correlation between the total HDRS score and the presence of depression according to the PHQ-9. RESULTS: In total, 101 participants were enrolled in this study. The principal component analysis (PCA) type factor analysis with varimax rotation found a high-grade correlation between HDRS individual items and the total score. The total variance, explained by five factors, was 64.4%. Cronbach's standardised alpha coefficient was 0.86 for the overall scale. Correlations between the total HDRS score and the PHQ-9 score, and its various items, were significant. The ROC curve analysis showed good sensitivity (80.8%) and specificity (91.1%). CONCLUSION: The Tunisian version of the HDRS is an acceptable instrument to screen depression in individuals who have attempted suicide.

[Parathyromatosis: An uncommon cause of recurrent hyperparathyroidism]. / Parathyromatose : une cause rare d'hyperparathyroïdie récidivante.

INTRODUCTION: Parathyromatosis is a rare cause of recurrent hyperparathyroidism. It results from hyperfunctioning parathyroid tissue scattered throughout the thyroid bed region. CASE REPORT: A 51-year-old man with a history of parathyroidectomy, presented 18 years later with recurrent primary hyperparathyroidism. Surgical exploration identified a single parathyroid gland. The act was completed by a central compartment dissection and ipsilateral lobectomy. The patient was free of recurrence after a one-year follow-up. CONCLUSION: Parathyromatosis a rare cause of recurrent hyperparathyroidism. Its management is challenging. Extensive surgery is required with clearance of the central neck compartment and homolateral lobectomy. Medical therapy could be used to decrease parathormone level in recurrent parathyromatosis.

Maternal low-protein diet affects bone mass and mineral metabolism in suckling rats.

This study was performed to analyse the effects of low-protein diet (7%) on bone mass and mineral metabolism in rat pups whose mothers were submitted to protein-restricted diet during late pregnancy and early post-natal periods. For this purpose, 12 pregnant Wistar rats were divided into two groups of six animals each: a control group with free access to standard diet (20% protein) and protein-restricted group (PR) fed with low-protein diet (7% protein) from the 14th day of pregnancy until day 14 after delivery. Body weight, femur bone mass, plasma thyroid hormones (FT(4) and FT(3)), biochemical bone marker levels [alkaline phosphatase (ALP), tartrate-resistant acid phosphatase (ACP)] and bone DNA content were recorded. In undernourished pups, a decrease in body weight (-47%, p < 0.001) in skeletal growth (-11%, p < 0.001) and in bone DNA content (-48%, p < 0.001) were observed. Plasma protein and albumin levels and thyroid status were also decreased in undernourished rat pups compared with those of control group. The circulating amino acid levels were decreased in pups. While in their mothers, some of them were increased and the others were decreased. A positive correlation was observed between bone mass and plasma thyroid hormone levels and ALP activity and plasma protein levels, and a negative correlation with ACP activity. Plasma ALP levels were decreased by 19%, whereas plasma tartrate-resistant ACP levels were increased by 33% indicating a hyperactivity of bone remodelling. These results showed that protein-restricted diet given to mothers during late pregnancy and early post-natal periods induced changes in body weight, skeletal growth and bone metabolism in their offspring.

In situ endocrine disrupting effects of cadmium on the reproduction of Ruditapes decussatus.

The gulf of Gabès is well known for its multiple contaminations which are closely associated with the past and present industrial and anthropogenic activity. In order to evaluate in situ the cadmium bioaccumulation in the clam Ruditapes decussatus sampled in this area, we measured cadmium concentrations in the whole soft tissues and in the digestive gland during one year. Energy reserves (proteins, glycogen, lipids) were monitored during gametogenesis in the remainder (mantle, adductor muscle, foot, siphons) of clams. Sex steroids (progesterone, testosterone, estradiol-17beta) were also measured by radio-immunoassay (RIA) in the gonads. The results showed that cadmium varied according to the reproductive cycle. High values were recorded at the resting stage in both sexes, during the gamete development and maturation in males and at the ripening and partially spawn stages in females. No significant changes in protein levels were observed in both females and males. However, high levels of glycogen and lipid reserves were recorded during the gametogenesis activity (from the development to the partially spawn stages). For steroid analyses, the results showed no important changes in testosterone levels all along the reproductive cycle. Fluctuations of sex steroids (especially progesterone and estradiol-17beta) could suggest their possible role as endogenous modulators of gametogenesis in R. decussatus. Correlation matrix and multiple regression models were also proposed to describe negative and significant relationship between cadmium and (glycogen, progesterone, testosterone and estradiol-17beta). These correlations may suggest the involvement of cadmium in the dysfunction of energy status and the endocrine disruption which could impede reproduction.

Variation of steroid concentrations during the reproductive cycle of the clam Ruditapes decussatus: a one year study in the gulf of Gabès area.

Progesterone, testosterone and estradiol-17beta were measured by radio-immunoassay (RIA) in the gonads of the clam Ruditapes decussatus. The reproductive cycle was also investigated. Our study covered a period of one year, from September 2003 to August 2004. The chosen site "Kerkennah", located out of industrial effluents, belongs to the gulf of Gabès area (Tunisia). Steroids varied from 178 to 2459 pg g(-1) wet mass for progesterone, from 40 to 326 pg g(-1) wet mass for testosterone and from 10 to 235 pg g(-1) wet mass for estradiol-17beta in females. However in males, these steroids ranged from 304 to 2303 pg g(-1) wet mass for progesterone, from 81 to 381 pg g(-1) wet mass for testosterone and from 48 to 168 pg g(-1) wet mass for estradiol-17beta. The reproductive cycle of R. decussatus, investigated by histological examination of gonadic sections, showed that gametogenesis occurred from April to February in males and from April to November in females. Progesterone and testosterone increased at the end of gametogenesis in both sexes. The highest estradiol-17beta was recorded at the beginning of vitellogenesis in females. Fluctuations in the levels of sex steroids during the reproductive cycle suggest their possible role as endogenous modulators of gametogenesis in R. decussatus. Although this species is considered as gonochoristic, 0.83% of hermaphrodites were observed.

[Significance of "anti HBC alone" serological profile in 284 patients suspicious of being infected with hepatitis B virus]. / Signification du profil sérologique "anticorps anti-HBC isolés" chez 284 patients suspects d'être infectés par le virus de l'hépatite B.

The "anti-HBc alone" serological profile is a frequent finding in hepatitis B virus infections, but little is known about its clinical significance. The aim of this study was to explore the 'anti-HBc alone' serological profile obtained by immunosorbent assay (ELISA) in 284 patients suspicious of being infected with hepatitis B virus. Sera were screened for following serological markers: HBs Ag, anti-HBc and anti-HBs antibodies using immunoradiometric assay (IRMA) and for HBV DNA using polymerase chain reaction. Among 284 studied sera with 'anti-HBc alone' serological profile, 124 were positives for anti-HBs antibodies by IRMA and corresponding to a recovered form of hepatitis B. Nineteen sera were negatives for anti-HBc antibodies, suggesting false positive results by ELISA. Two sera were found positives for HBs Ag by IRMA, which are related to authentic hepatitis B. HBV DNA was positive in 4 sera, suggesting occult hepatitis B. This study indicates that "anti-HBc alone" serological profile is most often correlates with recovered hepatitis B infection, but it can mask an occult hepatitis B.

Changes in growth rate and thyroid- and sex-hormones blood levels in rats under sub-chronic lithium treatment.

Lithium therapy, mainly used in curing some psychiatric diseases, is responsible for numerous undesirable side effects. The present study is a contribution to the understanding of the pathophysiological mechanisms underlying lithium toxicity. Male and female mature rats were divided into three batches and fed commercial pellets: one batch was the control and the second and third batches were given 2 g (Li1) and 4 g (Li2) of lithium carbonate/kg of food/day, respectively. After 7, 14, 21 and 28 days, serum levels of free tri-iodothyronine (FT3), thyroxine (FT4), testosterone and estradiol were measured. Attention was also paid to growth rate and a histological examination of testes or vaginal mucosa was carried out. In treated rats, a dose-dependent loss of appetite and a decrease in growth rate were observed, together with symptoms of polydypsia, polyuria and diarrhea. Lithium serum concentrations increased from 0.44 mM (day 7) to 1.34 mM (day 28) in Li1 rats and from 0.66 to 1.45 mM (day 14) in Li2 rats. Li2 treatment induced a high mortality after 14 days, reaching 50-60% in female and male animals. From these data, the LD50 (14 days Li2 chronic treatment) was calculated to be about 0.3 g/day per kilogram of animal, leading to Li serum concentrations of about 1.4 mM. A significant decrease of FT3 and FT4 was observed in treated rats. This effect appeared immediately for the highest dose and was more pronounced for FT3, resulting in an increase of the FT4/FT3 ratio. In males, testosterone decreased and spermatogenesis was stopped. Conversely, in females, estradiol increased in a dose-dependent manner as the animals were blocked in the diestrus phase at day 28. This finding supports a possible antagonistic effect of lithium on the estradiol receptors.

Food restriction induced thyroid changes and their reversal after refeeding in female rats and their pups.

In the present study, two groups of pregnant female rats were submitted to food restriction (24 h fast versus 24 h diet intake) from the 14th day of pregnancy until either the 14th day (group B) or the 4th day after parturition (group C). All pups and their mothers were sacrificed on day 14 after delivery. The body weight of the 14-day-old pups (group B) was 46% less than the controls (group A). Free thyroxine and free triiodothyronine levels in the plasma were reduced by 44 and 16% in pups and by 20 and 36% in their mothers, respectively. These reductions were correlated with a decrease in thyroid iodine content of the pups (-50%) and their mothers (-24%). Radioiodine uptake (131I) by the thyroid gland of pups was significantly increased by 27%. Plasma TSH levels were decreased by 38% in pups and by 44% in dams. Morphological changes in thyroid glands were observed in energy restricted dams and in their pups. Some of follicles in pups were empty. Moroever in dams, we noted the presence of peripheral resorbed vacuoles, sign of thyroid hyperactivity. After a refeeding (group C) period of ten days, total recovery occurred in plasma thyroid hormone levels (FT4 and FT3) and in thyroid iodine contents of pups in spite of a partial recovery of body weights and plasma TSH levels. In dams, a partial recovery occurred in plasma thyroid hormone levels in spite of total recovery in thyroid iodine contents, while plasma TSH levels exceeded control values. A significant amelioration in thyroid histological aspects was observed in pups and their dams.

[Hypothyroidism following cervical irradiation in the management of carcinoma of the nasopharynx and of the breast: a prospective study on eighty-four cases]. / Hypothyroïdie après irradiation cervicale dans le traitement des cancers du nasopharynx et du sein: étude prospective à propos de 84 patients.

PURPOSE: 1/ To evaluate the incidence of hypothyroidism following radiotherapy in the management of breast and nasopharyngeal carcinomas, 2/ to define the role of a systematic post therapeutic screening. PATIENTS AND METHODS: From January 1996 through March 2001 a systematic evaluation of the clinical and the biological thyroid function was performed on a cohort of 84 patients that received supraclavicular irradiation. Selected patients had either a mammary (37 cases) or a nasopharyngeal (47 cases) carcinoma. Initial work up included thyroid inspection and palpation, and biological tests: serum FT4 and TSH levels, radioimmunochemistry, completed by dynamic thyroid stimulation, using TRH, in case of border line low T4 or isolated high TSH levels. Tests were repeated every three months the first year, and then every six months. Replacement therapy with L Thyroxin was administered in case of hypothyroidism. RESULTS: All selected patients had a normal function initially. With a mean two years follow up (1-5 years), 24 patients (29%) experienced hypothyroidism, half of whom (13 cases) being purely biological. Five patients (11%), with a nasopharyngeal carcinoma, presented also with associated pituitary failure. Clinical symptoms were minor or mild in all cases. Hypothyroidism was detected at a mean 21 months follow up. In 2 patients, hypothyroidism disappeared spontaneously within 6 months. Possible predictive factors were evaluated: age of the time of radiation, gender, percentage of irradiated thyroid, total dose, dose per fraction, tumour type and chemotherapy. Only age appeared significantly correlated with thyroid dysfunction (range: 10-30 years, P=0.002). CONCLUSION: Hypothyroidism is a frequent and certainly underestimated complication following radiotherapy of the neck. In such patients, a systematic clinical and biological evaluation every three months the first year, and then every six months until five years is recommended.

[Induction and reversibility of thyroid proliferative changes in suckling rats given thiocyanate]. / Induction et réversibilité d'action du thiocyanate sur la fonction thyroïdienne chez le rat en période d'allaitement.

Potassium thiocyanate given in the drinking water of pregnant rats led to decreased body weight in their 14-day-old offspring (27%) without altering thyroid weight. Reduction of the suckling rat's body weight could be explained be defective thyroxinemia (38). Plasma FT3 and TSH were unchanged after thiocyanate treatment. The biochemical changes were in agreement with the histological aspects of the hypothyroid animals. The typical pattern was hyperplastic goiter. Colloid volume was reduced compared with controls. Presence of resorbed peripheral vacuoles, a sign of thyroid hyperactivity, was disclosed by a three-fold increase in radioiodide (131I) uptake compared with controls. When the antithyroid drug was removed from the mother's milk, the pups'weight increased but did not reach control values. Plasma thyroid hormone levels returned to normal and even exceeded control values in spite of partial recovery of thyroid iodine content when thiocyanate treatment was stopped for ten days.

[Thiocyanate and central nervous system maturation of young mice]. / Effets du thiocyanate sur la fonction thyroïdienne et la maturation du système nerveux central de la jeune souris.

Potassium thiocyanate, given to the drink of pregnant mothers provoked a body weight decrease of 14 day-old mice (-18%), without perturbations of cerebrum and cerebellum weights. The reduction of pups' body weight could be explained by a decrease of plasmatic thyroid hormone levels: FT3 and FT4, (-54; -57%) in youngs and (-66; -49%) in their mothers. A defect of thyroid hormone levels, observed in young mice, provoked a decrease of cerebrum and cerebellum protein concentrations (-15 and -13%) respectively. Modifications of biochemical parameters confirmed the histological aspects of hypothyroid mice cerebellum with purkinje cells incompletely differentiated. When thiocyanate ion was removed from mothers' drink, we have noted in pups a partial return of some biochemical parameters (iodine thyroid contents, protein concentrations of cerebrum and cerebellum) and of cerebellum histological aspects. While thyroxinemia (FT4) and plasmatic FT3 levels were completely restored and even exceeded control values, which were necessary for central nervous system maturity of young.

[Propythiouracil and perchlorate effects on thyroid function in young and lactating mice]. / Effets de deux antithyroïdiens de synthèse (propylthiouracile et perchlorate) sur la fonction thyroïdienne de la souris en période d'allaitement.

We have studied the effects of propythiouracil (PTU) or perchlorate (CIO(4)(-)), given to the mothers' drink from the 15(th) day of pregnancy until the day of sacrifice, on thyroid function of suckling mice. Antihyroid drugs (PTU or CIO(4)(-)) provoked growth perturbations of young mice during studied ages from 6 to 18 days. A decrease of body weight was respectively as follows: 14 and 22% in 6 day-old mice; 16 and 23% in 10 day-old mice; 18 and 18% in 14 day-old mice; 19 and 11% in 18 day-old mice. We have noticed an hypertrophy of thyroid glands of pups and their mothers caused by an increase of pituitary TSH. Thyroid follicles presented the aspect of hypothyroid animals with an increase of follicular number and vascularisation. Structural modifications confirmed biochemical results. In fact thyroid iodine contents decreased strongly in young as follow: 40 and 43% in 6 day-old mice; 51 and 50% in 10 day-old mice; 66 and 84% in 14 day-old mice; 54 and 89% at 18 day-old mice and in their mothers (50, 37%; 59, 54%; 75, 65% and 85, 72%) respectively after PTU or CIO(4)(-) treatment. A decrease of iodine thyroid gland was accompanied by an important fall of free thyroid hormones levels (FT3 and FT4) in young and adult mice. A decrease of thyroid hormonemia could explain the pups' growth perturbations.

Effect of chronic lead exposure on kidney function in male and female rats: determination of a lead exposure biomarker.

Several cytotoxic chemical pollutants inducing peroxidative damages are liable to induce kidney failure. Among these pollutants we find heavy metals such as: lead, nickel, cadmium, vanadium and mercury. Lead is one of the most dangerous metals because it is widely spread in the environment, and because it may be a source of several nervous diseases. The aim of this study is to provide evidence concerning the effect of this metal on the renal function and to try to determine a storage corner in the organism which serves as an indicator of a lead intoxication. Lead acetate was administered by oral route in the drinking water to adult rats aged three months at the rate of 0.3% (P1) and 0.6% (P2). Reference rats received distilled water to drink under the same conditions. The treatment continued for 15, 30, 45, 60 and 90 days. The creatinemia, uremia, glycemia and creatinuria are determined by colorimetric techniques. Lead concentration in blood as well as the lead content of the tail are determined by atomic absorption after nitroperchloric mineralization at the liquid stage. The results showed an increase of creatinemia on the 30th day of the experiment for both sexes in (P1 and P2). The same happened for ureamia. The increase of these two parameters would indicate a renal deficiency which is confirmed by a decrease of creatinuria and urinary pH observed mainly on and after the 45th day of the experiment. An increase of the renal relative weight was noticed in P1 and P2 on the 30th day of the treatment. The determination of the concentration of lead in the blood shows that this factor increases among treated subjects in a constant way, independently of the dose and the duration of the treatment. Nevertheless, the rate increase of lead in the tail seems to be dose-dependent. In conclusion, lead administered by oral route causes a renal deficiency to the rat without distinction between males and females. In addition, the tail seems to be a reliable exposure biomarker that demonstrates lead intoxication. The tail seems to be a dosimeter of lead bio-accumulation. It constitutes an endogenous source of lead impregnation. The concentration of lead in the blood is only an indicator of recent exposure.

[Chronic cor pulmonale caused by hydatid embolism complicating hepatic hydatid cyst]. / Coeur pulmonaire chronique par embolies hydatiques compliquant un kyste du foie.

An hydatid cyst of the left lobe of the liver, associated with right heart failure, was diagnosed in a 61-year-old man presenting with dyspnoea. Doppler echocardiography combined with cardiac catheterization demonstrated the presence of pulmonary precapillary hypertension. Pulmonary perfusion scintigraphy with Technetium-labelled albumin microspheres demonstrated multiple pulmonary embolisms, leading to a diagnosis of postembolic chronic cor pulmonale. Due to the absence of thrombophlebitis and ultrasound signs of an intracaval hydatid membrane, floating at the level of the cyst of the left lobe of the liver, the diagnosis of parasitic postembolic chronic heart pulmonale, due to fistulization of an hepatic hydatid cyst into the inferior vena cava, was established. Only chemotherapy was proposed in this patient due to dissemination of the hydatid material in the lungs.

[Technetium 99m labeled dimercaptosuccinic acid (99m Tc-DMSA) scintigraphy in the diagnosis and follow-up of urinary infections in children]. / Apport de la scintigraphie à l'acide dimercaptosuccinique marqué au technétium 99m (99mTc-DMSA) dans le diagnostic et le suivi des infections urinaires de l'enfant.

BACKGROUND: The site of a urinary tract infection (UTI) is located by clinical findings plus imaging techniques. Renal imaging with technetium 99mTc-dimercaptosuccinic acid (99mTc-DMSA) has shown promise but its efficacy for detecting acute pyelonephritis is still debated as is its ability to differentiate between acute, potentially curable disease and scarring, definitive changes. PATIENTS AND METHODS: The files of all the 166 patients that underwent one or two (32 patients) 99mTc-DMSA imaging sessions for UTI in 1989 and 1990 in our department were analysed. The results of this technique were compared with the clinical and laboratory data and with those of other imaging techniques (ultrasonography and retrograde voiding cystourethrogram). The patients (92 girls and 74 boys, mean age: 5 years, range 15 days-17 years) were assigned to one of 3 categories: 1) acute pyelonephritis (27 patients), 2) low UTI (60 patients) and 3) uncertain UTI (79 patients), on the basis of the clinical and laboratory data. RESULTS: The first 99mTc-DMSA imaging was normal in 110 children; changes were unilateral in 45 and bilateral in 11 children. Images suggesting either acute or chronic changes were observed respectively in 19 and 48 children. 4 of the 7 acute changes were normalized on the second radioisotope scanning while 2 became worse; 19 of the 23 chronic changes were unchanged at the second scanning. Radioisotope scanning changes were seen in 81% of the patients classified as acute pyelonephritis and in only 27% of those with lower UTI. Reflux was detected in 56% of abnormal kidneys and in 36% of normal kidneys. The results of radioisotope scanning and ultrasound scan findings were not correlated in 24 patients (19 only abnormal radioisotope imaging, 5 only abnormal ultrasound scan). CONCLUSIONS: DMSA scans are useful for investigating and following UTI. They help to distinguish acute pyelonephritis and lower UTI. It is a reliable method of detecting structural abnormalities and identifying children at risk of progressive renal damage.

[Therapeutic efficiency of iodine 131 in autonomous thyroid adenoma and toxic multinodular goiter. Apropos of 59 cases]. / Efficacité thérapeutique de l'iode 131 dans l'adénome thyroïdien autonome et le goitre multinodulaire toxique. A propos de 59 cas.

Our study dealt with 81 patients treated by iodine 131 for autonomous goiter. We have followed 59 patients during about a year. The global therapeutic efficiency is of 73% and the risk of hypothyroidism is very weak. The administration of a high activity (greater than 15 mCi) of iodine allows to get a faster recovery, a better therapeutic efficiency and permits to reduce the number of cures (therefore, to reduce the irradiation of the patient), nevertheless, the risk of hypothyroidism is very slight. The advantages of metabolic radiotherapy (low cost, facility of administration, efficiency) make it preferable to surgery, above all with patients that are more than 40 years old, for whom the radiation risk is practically null (hereditary diseases, cancer).