High prevalence of antineuronal antibodies in Tunisian psychiatric inpatients.

The authors aimed to determine the prevalence of antineuronal antibodies in 103 psychiatric inpatients and 41 control subjects with no history of malignancies or neurological disorders. All sera were tested by indirect immunofluorescence and positive sera by immunoblot. Using immunofluorescence, antineuronal nuclear autoantibodies were detected in 20 patients and none of the control subjects, and antibodies reacted with the cytoplasm of Purkinje cells in six patients and two control subjects. The immunoblot confirmed well-characterized antineuronal antibodies only in five patients: two had anti-Ri and three had anti-Yo antibodies. After a follow-up of 5 years, none of these patients developed neurological disorder or malignancy.

[Burn out in health care providers: a Tunisian study about 142 nurses]. / L'épuisement professionnel du soignant: Etude tunisienne à propos de 142 infirmiers.

BACKGROUND: Burnout is a syndrome which affects preferentially help professions, having a strong emotional interpersonal implication. AIM: To assess the prevalence of burn out in a sample of Tunisian nurses, and to determine its causes and perceived repercussions. METHODS: In a first step, we assessed the work conditions, the perceived burn out and its possible consequences in 142 nurses from 12 different wards. In a second step, we used the Malasch Burn Inventory to assess the burn out symptoms in ours ample. RESULTS: More than two thirds (69%) of our sample had a burn out. Forty five point eight percent of the affected professionals had a high level of emotional distress, 36.6% had a high level of depersonalization and 22.5% had a low level of professional fulfillment. The high caseload was the first cause of burn out (72.5% of professionals) and was associated to a moderate level of burn out (OR=3.80; 95%IC: 1.079-13.420 ; p = 0.038). Role ambiguity and undefined responsibilities were associated to a high level of emotional distress (p=0.04) and depersonalization (p=0.03), and a low level of professional fulfillment (p=0.0001). High scores of emotional distress were associated to a high number of work hours (p=0.006) and less than 10 years in carrier duration (p=0.008). In our study, feelings of uselessness were associated to high levels of emotional distress (p=0.05) and depersonalization (p=0.002) on the one hand, and to a lower level of personal fulfillment on the other hand (p=0.04). Moreover, we found that cases with suicide ideations had a higher level of burn out (p=0.04). Concerning physical symptoms, emotional distress was associated to multiples somatic complains. CONCLUSION: Our results corroborate partially with those of the literature and illustrate some parameters that can be the cause of burnout, such as working conditions, role ambiguity, and lack of experience among the young nurse. Therefore, it is important to take into consideration this various factors had their impact on quality of life of caregivers.

Spectrum of autoantibodies in Tunisian psychiatric inpatients.

One hundred and three psychiatric inpatients (74 men) were assessed for a wide spectrum of autoantibodies including antinuclear, antismooth muscle, antimitochondrial, antiDNA, anti-phospholipid, anti-cardiolipin IgG and IgM, antikeratin, rheumatoid factor, antithyroperoxydase, antigliadin IgA and IgG, antitransgutaminase, and antiendomysium antibodies. Four groups of patients were considered separately, including 47 with schizophrenia, 23 with schizoaffective disorder, 16 with bipolar disorder and 17 patients with other different psychiatric diagnosis. Forty one healthy, age- and sex-matched blood donors were used as a control group. There were no significant difference in the prevalence of the different autoantibodies between patients (N = 103) and controls except for antigliadin IgG (30.1 vs 9.8 respectively, p = 0.01). Presence of autoantibodies was influenced by age but not by sex or treatment. As for diagnosis categories, patients with bipolar disorder presented significantly more autoantibodies than the three other categories and controls. These results point out a possible autoimmune activation in at least a subgroup of psychiatric patients especially amongst those suffering from bipolar disorder.

Plasma homocysteine in schizophrenia: determinants and clinical correlations in Tunisian patients free from antipsychotics.

The existence of association between hyperhomocysteinaemia (HHC) and schizophrenia has been suggested by several recent studies. This study aimed to determine the prevalence of HHC and its main determinants, and sought a correlation with clinical features in Tunisian patients with schizophrenia. Plasma homocysteine (Hcy), folate, and vitamin B12, as well as the C677T methylene tetrahydrofolate reductase (MTHFR) polymorphism, were studied in 33 patients with schizophrenia, all free from antipsychotic treatment, and 35 age- and smoking-habit-matched healthy subjects as controls. Biochemical determinations and psychometric evaluations were carried out in patients before the administration of antipsychotics. The prevalence of HHC was higher and plasma B12 vitamin was significantly lower in patients. There was no significant difference in genotypic distribution and allelic frequency of the C677T MTHFR polymorphism between groups. Hcy was significantly correlated to the 'anhedonia-asociality' subscales of the Scale for the Assessment of Negative Symptoms (SANS). This study showed an association between HHC and schizophrenia, especially with the negative symptoms of the disease. In the Tunisian population, HHC in schizophrenia seems to be linked to vitamin B12 deficiency, likely caused by a lack of dietary animal proteins.

[Comparative study of appendical mucocela and pseudomyxoma peritonei. About 25 cases]. / Etude comparative des mucoceles simples et des mucoceles compliques de pseudomyxome. A propos de 25 observations.

AIM: to study the clinicopathological features of the different types of appendical mucocele and to compare them with those of pseudomyxoma peritonei. METHODS: 25 cases of appendical mucocele were operated in the Cap-Bon region in Tunisia during a period of 13 years from 1994 to 2006. RESULTS: 9 retentionnal cysts, 13 mucinous cystadenomas, one serrated adenoma, one hyperplasia of the mucosa and one cystadenocarcinoma were diagnosed. Five cystadenomas as well as the only case of cystadenocarcinoma were associated with pseudomyxoma peritonei. Pseudomyxoma peritonei occurred 20 years later than in simple appendiceal mucocèle and complicated 5 cases of cystadenoma with low grade dysplasia and 1 case of cystadenocarcinoma. CONCLUSION: Preoperative diagnosis of appendical mucocele and pseudomyxoma peritonei should be made on scannographic features in order to assess the adequate surgical management.