Molecular genotyping of Echinococcus granulosus using formalin-fixed paraffin-embedded preparations from human isolates in unusual tissue sites.

Cystic echinococcosis (CE) caused by Echinococcus granulosus remains a serious problem worldwide for issues relating to public health and the economy. The most predominantly affected sites are the liver and the lungs, but other organs such as the heart, the spleen and the peritoneum can also be infected. Access to cysts from uncommon sites has limited genomic and molecular investigations. In the present study, genotypes of E. granulosus sensu lato were identified from formalin-fixed paraffin-embedded tissues (FF-PETs) implicated in human CE. Tissue samples were obtained from 57 patients with histologically confirmed CE. DNA samples were analysed using Egss 1 polymerase chain reaction (PCR) specific to the mitochondrial 12S rRNA gene of E. granulosus sensu stricto. All cysts were typed as E. granulosus sensu stricto with up to 35% of the liver and 16.6% of lungs being the most frequently infected, and up to 48.4% of samples being from rare sites. No correlation was found between cyst site and either the gender or the age of patients. This study demonstrates the possibility of exploiting atypical cysts using FF-PET samples and highlights the predominance of E. granulosus sensu stricto species in the Tunisian population, even in unusual infection sites.

[Validation of the dialectal Arabic version of Barratt's impulsivity scale, the BIS-11]. / Validation de la version en arabe dialectal de l'échelle d'impulsivité de Barratt, la BIS-11.

INTRODUCTION: Impulsivity is a symptom of several disorders such as personality disorder, bipolar disorder, suicidal behaviour, substance use disorders, schizophrenia...Forensic psychiatry is particularly concerned with impulsivity. It increases the risk of violence among clinical populations and figures in various instruments such as the HCR-20, the VRAG and the PCL-R to assess violence risk. It is one of many dimensions that can lead to aggressive behaviour among psychiatric patients. The Barratt Impulsiveness Scale (BIS), in its 11th version, is a 30-item self-report instrument that helps assessing impulsivity trait among normal and clinical populations. The BIS is the most commonly administered self-assessment of impulsiveness. As of March 2009, there have been 551 citations of the BIS-11 among many publications. The purpose of the present study is to examine the psychometric properties of the Arabic translation of the BIS-11th version in a sample of the general population and to identify an eventual correlation between impulsivity and socio-demographic characteristics. PATIENTS AND METHODS: This is a prospective study conducted over a five-month period, from June to October 2010, and including 134 persons from the general population having provided their informed consent. The dialectal Arabic version was carried out by translation from English to dialectal Arabic followed by a back translation to English. Some questions were modified to be understood by a population with low education. After giving their verbal informed consent, the participants filled in the Arabic version of the BIS-11. For the illiterate, responses and quotations were performed by the interviewer. The persons were also asked to fill in socio-demographic data. Cronbach's coefficient was calculated, and then we assessed impulsivity prevalence and a correlation between demographic features and impulsivity scores. For the analyses, the statistical software SPSS 11 was used. RESULTS: The sex ratio is 1.02. Most of the interviewed persons were 20 to 49 years old. Around 25.4% of the sample were analphabets, 32.1% had primary education, 29.1% had secondary education and 13.4% were undergraduates. The Cronbach's alpha was respectively 0.66 for attention, 0.72 for motor impulsivity, 0.61 for lack of planning and 0.78 for total impulsivity. Factor analysis identified three factors explaining the total variance of 32.6%. Impulsivity prevalence was 9%. We did not find significant correlation between demographic features and impulsivity scores. DISCUSSION: Limits of the study: scale stability over time was not verified. This was due to the difficulty in re-inviting the same persons to fulfil the scale a second time. Because no instrument for assessing exists in Arabic, comparison was not possible between the translated Barratt's scale and the reference. Our sample represents the general population. This choice was justified in order to study an eventual correlation between impulsiveness and socio-demographic characteristics. We must mention difficulties when asking persons with low education to complete the scale, what may have caused a poorer performance of the scale due to difficulties in understanding some questions. Moreover, we had chosen a non-clinical sample. The validation of the scale could be performed in a clinical population. The measure of internal consistency (Cronbach's alpha) fell within an acceptable range (0.61-0.78), suggesting that the Arabic version of the BIS-11 is reliable. Exploratory factor analysis of the current version identified three factors, but these factors differed from those of other translated versions. CONCLUSION: There is growing interest in the impulsivity concept. Forensic psychiatry is particularly concerned by impulsivity. In fact, it is related to psychiatric patients' violence. Impulsivity also reveals the problem of responsibility assessment in psychiatric expertise and the dangerousness of psychiatric patients. The Arabic version of the BIS-11 has a good apparent and internal consistency. This version could be useful in assessing psychiatric patient's dangerousness.

[Retrospective study of the distribution and the fertility of hydatid cysts in the child in Tunisia]. / Étude rétrospective de la distribution et de la fertilité des kystes hydatiques chez l'enfant en Tunisie.

PURPOSE OF THE STUDY: Our aim was to study the distribution and the fertility of the hydatid cysts in function of the age and the sex of patients and to identify the strain(s) responsible(s) of the children hydatidosis. PATIENTS AND METHODS: We have analyzed a total of 241 cysts coming from 195 children aged 2 to 16 years operated in the CHU F. Bourguiba of Monastir during the period from November 1999 to December 2009. For each cyst, the localization and the fertility of the métacestode as well as age, sex and origin of the patient are listed. Identification of strains was carried out by PCR/RFLP and has targeted the ribosomal gene ITS1. RESULTS: The lung was the primary localization of cyst (61.8%) followed by the liver (34.85%). The greatest number of cases is observed in the age groups 4-9 years (138 cases) where children's infection is more frequent in the male than in the female sex. The fertility of the cyst was independent of its site or its size and no incidence of age of children was detected. The G1 sheep strain is responsible for the contamination of children. CONCLUSION: The cystic echinococcosis described as a young adult disease may actually observed at any age and remains a serious problem of public health in Tunisia.

[Stress and burnout among Tunisian teachers]. / Stress et épuisement professionnel des enseignants tunisiens.

INTRODUCTION: Burnout, or professional exhaustion syndrome, is defined as a state of emotional, mental and physical exhaustion caused by excessive and prolonged stress at work. Despite the fact that it is not a recognized disorder in the DSM-IV, burnout has been widely described among medical and paramedical staff. In Tunisia, all the studies about this syndrome have only considered populations of doctors. However, professional exhaustion syndrome is not only limited to the medical sector, but can also be seen in any profession involving a relation of help. Thus, the teaching profession seems to be concerned with this syndrome. In fact, in our clinical practice, we are increasingly confronted with teachers' suffering. The latter face increasing difficulties in their work and moreover some of them can no longer resist and thus become vulnerable to the professional exhaustion syndrome. OBJECTIVE: The aim of this study was to evaluate burnout among a population of Tunisian teachers and to examine the professional stressors associated with teachers' burnout. METHODS: Our study was a transversal study conducted over five months (from October 2009 to February 2010) and it concerned teachers working in the public high schools of Manouba (Tunisia). The participants completed a self-questionnaire dealing with professional stressors. Five types of professional stressors were identified in the literature: bad working conditions, work overload, administrative difficulties, organizational factors and difficulties with pupils and their relatives. They were also explored by the scale of the burnout: the Maslach Burnout Inventory (MBI), which is the best-studied measurement of burnout in the literature. We used the French version of the MBI adapted to educational settings. It is a scale composed of 22 items and three dimensions: emotional exhaustion (nine items), dehumanization (five items) and reduced personal accomplishment (eight items). In our study, we considered a teacher was suffering from burnout when at least two among the three dimensions of this scale were pathological. RESULTS: From the total number of teachers working in public high schools of Manouba (n=876), only 398 teachers filled in our questionnaires. Hence the rate of participation was 45.4%. The mean age of those participants was 40.04 years. 52.3% of them were women (sex ratio=0.91) and the great majority was married (81.8%). The burnout syndrome was found in 21% of those teachers: Moderate professional exhaustion was found in 16.4% of cases and severe professional exhaustion was found in 4.6%. A high emotional exhaustion was found in 27.4% of cases. A percentage of 16.1 of participants had a high dehumanization and 45.5% of them were susceptible to reduced personal accomplishment. The majority of teachers (66.4%) declared being stressed at work. The professional stressors reported by the teachers were in decreasing order of rate: bad working conditions (80.3%), overload work (75.2%), administrative difficulties (70.4%), difficulties with pupils and their relatives (64.4%) and finally organizational factors (57.1%). In our study, we found a strong association between burnout syndrome among teachers and three types of professional stressors which were: bad working conditions (p=0.0017), administrative difficulties (p=0.005) and difficulties with pupils and their relatives (p=0.005). The organizational factors and the work overload were not associated with the burnout syndrome. CONCLUSION: The job of teaching accumulates many difficulties. Some Tunisian teachers cannot tolerate this professional stress and develop a burnout. This syndrome leads to a teachers' psychological distress with the risk of an increase in absenteeism at work. So, we hope that this study will give rise to future research on stress, coping and burnout among Tunisian teachers, with theoretical aims as well as practical applications to prevent and reduce the risk of this problem.

Confirmation and follow-up of neurocysticercosis by real-time PCR in cerebrospinal fluid samples of patients living in France.

Neurocysticercosis diagnosis is based on a combination of clinical, epidemiological, radiological, and immunological findings. We describe a real-time PCR assay for the confirmation of neurocysticercosis diagnosis in cerebrospinal fluid. The assay, tested on samples from nine patients living in France and diagnosed with neurocysticercosis, had a detection rate of 83.3% and 100% specificity.

[Spouses and bipolar disorder]. / Conjoints et trouble bipolaire.

OBJECTIVE: To assess the quality of life of a population of spouses of bipolar patients compared with a control population. PATIENTS AND METHODS: We conducted a cross-sectional study which included two groups: a group of 30 spouses of patients followed for bipolar I disorder according to DSM IV criteria and a second group of 30 subjects from the general population. Both groups were matched by age, sex, marital status and socioeconomic level. This device was designed to limit the differences between the two groups solely those of the bipolar illness. Evaluating the quality of life was achieved using the quality of life scale: SF-36. This is a scale that has already been translated and validated in dialect Arabic. RESULTS: Regarding sociodemographic variables, the two study groups differed only for: recreation, friendly relations and the couple relationship that included more and better skills among the control group. In the categorical approach, the quality of life was impaired in 60% of spouses and 40% of controls with a statistically significant difference. The following standardized dimensions: mental health (D4), limitation due to mental health (D5), life and relationship with others (D6) and perceived health (D8) and mental component (CM) were significantly altered in patients' spouses compared to controls. We found significant differences between the two groups for: overall average score (51.1 vs. 68.2), mental health (D4), limitation due to mental health (D5), life and relationship with others (D6), perceived health (D8) and perceived health (D8) standards. DISCUSSION: The impairment of quality of life of bipolar patients' spouses is related to the extra responsibility, stress, financial problems and health problems, stigma, and loss of security of the person loved. CONCLUSION: Considering the consequences that the appearance of bipolar disorder on the patient's spouse may have, certain measures must be proposed to improve their quality of life.

Intrarenal urothelium proliferation: an unexpected early event following ischemic injury.

Identification of renal cell progenitors and recognition of the events contributing to cell regeneration following ischemia-reperfusion injury (IRI) are a major challenge. In a mouse model of unilateral renal IRI, we demonstrated that the first cells to proliferate within injured kidneys were urothelial cells expressing the progenitor cell marker cytokeratin 14. A systematic cutting of the injured kidney revealed that these urothelial cells were located in the deep cortex at the corticomedullary junction in the vicinity of lobar vessels. Contrary to multilayered bladder urothelium, these intrarenal urothelial cells located in the upper part of the medulla constitute a monolayered barrier and express among uroplakins only uroplakin III. However, like bladder progenitors, intrarenal urothelial cells proliferated through a FGF receptor-2 (FGFR2)-mediated process. They strongly expressed FGFR2 and proliferated in vivo after recombinant FGF7 administration to control mice. In addition, IRI led to FGFR phosphorylation together with the selective upregulation of FGF7 and FGF2. Conversely, by day 2 following IRI, renal urothelial cell proliferation was significantly inhibited by FGFR2 antisense oligonucleotide administration into an intrarenal urinary space. Of notice, no significant migration of these early dividing urothelial cells was detected in the cortex within 7 days following IRI. Thus our data show that following IRI, proliferation of urothelial cells is mediated by the FGFR2 pathway and precedes tubular cell proliferation, indicating a particular sensitivity of this structure to changes caused by the ischemic process.

[Schizophrenia and violence, incidence and risk factors: a Tunisian sample]. / Schizophrénie et violence: incidence et facteurs de risque à propos d'une population tunisienne.

INTRODUCTION: Schizophrenia appears to be the mental pathology the most associated with violence. The aim of this study is to show the incidence and the different risk factors of violence among schizophrenics. MATERIAL AND METHOD: We have compared a group of 30 violent schizophrenic inpatients with another group of 30 nonviolent schizophrenic inpatients hospitalised during the same period. These two groups have been matched according to age and gender. The comparison concerned: sociodemographic parameters, family and personal psychiatric history, legal antecedents, social insertion, clinic, Clinical Global Impressions (CGI), Global Impairment Scale (GIS) and Positive And Negative Syndrome Scale (PANSS) scores for admissions, familial support and insight, compliance to treatment, administered treatments, and awareness degree. RESULTS: Violent schizophrenics represent 18.07% of all hospitalisations and 26.08% of schizophrenic patients. When compared to violent schizophrenic patients, nonviolent schizophrenic patients have a better socioeconomic level (77% versus 43%), better professional adaptation (67% versus 10%) and familial support (60% versus 10%), better insight (87% versus 23%) and therapeutic control (70% versus 17%). Differences are significant. We found significantly more personal antecedents of inflicted violence within violent schizophrenics (50% versus 13%), more addictive behavior (53% versus 13%), and more paranoid and indifferentiated forms (87% versus 47%) than in nonviolent schizophrenics. The average of CGI scores was significantly higher within violent schizophrenics (5.27+/-0.8 versus 3.77+/-0.5). Conversely, the average of EGF scores was lowest (37.6+/-6.5 versus 47.8+/-5.6). The comparison of PANSS scores revealed that violent schizophrenic subjects are characterised by the existence of more positive signs and more general symptoms (34.4+/-4.7 versus 20.2+/-4.5; 55.1+/-11.4 versus 46.1+/-6.9). Violent schizophrenics are characterised by higher neuroleptic doses (2375+/-738 mg/d versus 1610+/-434 mg/d). Differences here are also significant. DISCUSSION: Addictive behaviour seems to considerably increase the risk of turning to violence. Thus in our study, 53% of violent patients showed an addictive behaviour. These results have also been reported by other authors. It is obvious that alcohol and drug abuse double the risk of violence among schizophrenic subjects. Psychotic decompensation and rich symptomatology increase the violent potential among the schizophrenics. In our study, the PANSS scores were higher among violent subjects. Nonviolent schizophrenic subjects have a lesser symptomatology of psychiatric disorders and a better outcome as shown by the CGI and EGF scores. In our study, the group of violent subjects needed higher neuroleptic doses and were noncompliant. Compliance permits the acquisition, and then maintains, the stability of the mental status and plays an essential role in decreasing dangerousness. In fact, violent schizophrenics exhibit low insight, implying diminished awareness of the legal implications of their acts, and are little aware of their illness and its dangerousness. In our study, we noted better familial support among nonviolent subjects. According to the literature, violent schizophrenics are characterised by a particularly hostile and rejecting familial environment. CONCLUSION: Awareness of these factors will allow us to provide improved prevention of violence within schizophrenic subjects.

[Cystic echinococcosis in children in Tunisia: fertility and case distribution of hydatid cysts]. / L'échinococcose hydatique de l'enfant en Tunisie: fertilité et localisation des kystes.

Cystic echinococcosis, which commonly starts during childhood or adolescence, is a serious problem of public health in Tunisia. For 121 children (161 cysts), the localization and fertility of cysts as well as viability of their protoscoleces were determined. Results indicated that the lung was the primary localization of cyst (59%) followed by the liver (35%). Children's infection is more frequent in male than in female (sex ratio 1.96) and the greatest number of cases is observed in the 4-9 year age groups (94 cases). The fertility of the cyst was independent of its site or its size and no incidence of age of children was detected. Nevertheless, the fertility rate is higher in females than in males for the liver localization.

Genetic differences between Tunisian camel and sheep strains of the cestode Echinococcus granulosus revealed by SSCP.

Ovine and dromedary Echinococcus granulosus isolates from Tunisia were identified as G1 and G6 strains based on polymorphism of the mitochondrial cytochrome C oxydase CO1. Single strand conformation polymorphism (SSCP) was used in order to examine the genetic variation within and between Tunisian G1 and G6 strains and to estimate the extent of selfing. The dromedary isolates are genetically distinct from sheep isolates (high value of genetic variation between populations: Fst= 0.46). No significant deficiency in heterozygotes was found in sheep isolates, whereas heterozygote deficiency (suggesting selfing) was found in a limited number of camel isolates.

[Unipolar versus bipolar depression: clues toward predicting bipolarity disorder]. / Dépression unipolaire versus dépression bipolaire: facteurs prédictifs d'une évolution bipolaire.

Bipolar and unipolar disorders share a common depressive clinical manifestation. It is important to distinguish between these two forms of depression for several reasons. First, prescribing antidepressors in monotherapy indubitably worsens the prognosis of bipolarity disorders. Second, postponing the prescription of a mood stabilizer reduces the efficacy of the treatment and multiplies the suicidal risks by two. The object of this study is to reveal the factors that distinguish between unipolar and bipolar depression. This is a retrospective study on patients' files. It includes 186 patients divided according to DSM IV criteria into two groups: patients with bipolar disorder type I or II with a recent depressive episode (123 patients) and patients with recurrent depressive disorder (63 patients). A medical record card was filled-in for every patient. It included socio-demographic data, information about the disorder, family antecedents, CGI score (global clinical impressions), physical comorbidity, substance abuse and personality disorder. In order to sort out the categorization variables, the two groups were compared using chi2 test or Fischer's test. With regard to the quantitative variables, the two groups were compared using Krostal Wallis's test or Ancova. Our study has revealed that bipolar disorder differs significantly from unipolar disorder in the following respects: bipolar disorder is prevalent among men (sex-ratio 2) while unipolar disorder is prevailing among women (sex-ratio 0.8); patients with bipolar disorder are younger than patients with unipolar disorder (38.1 +/- 5 years vs. 49.7 +/- years); the age at the onset of bipolar disorder is earlier than that of unipolar disorder (20.8 +/- 2 years vs. 38.7 +/- 5 years); family antecedents are more important in bipolar patients than in unipolar patients (51.1% vs. 33%). More importantly, bipolar disorder differs from unipolar disorder in the following aspects: The number of suicidal attempts (25.3% vs. 23.6%); the degree of substance abuse (15.4% vs. 14.5%); the level of somatic comorbidity (20.3% vs. 17.4%); the amount of anxiety manifestations (5.6% vs. 4.8%); the extent of personality disorder (30.8% vs. 23.8%); the degree of socio-professional impairment (bachelorhood and unemployment). On the other hand, we noted that unipolar patients differ from bipolar patients in terms of the frequency of hospitalizations (3.5 vs. 3.1) and the length of stays in hospitals (25.8 vs. 20.7 days) with significant differences of 0.003 and 0.0000001 respectively. Moreover, the CGI scores of unipolar patients are higher than those of bipolar patients. However, the difference is not significant. Consequently, an early distinction between bipolar and unipolar disorder is of utmost importance for the treatment of these two illnesses.

[Anastomotic false aneurysms after under-diaphragmatic bypasses: about 25 cases]. / Les faux anévrismes anastomotiques sur pontages sous-diaphragmatiques: a propos de 25 cas.

The purpose of our study is to determine the causes and the management of anastomotic aneurysms. We report the cases of 25 patients with a mean age of 64 years at the time of initial surgical revascularisation. The mean interval between the first operation and the occurrence of anastomotic aneurysm is 5 years (range 2 months-11 years). The treatment consists on the interposition of a graft in 8 patients, anastomotic angioplasty in 9 patients and the reconstruction of the anastomosis in 8 patients. Hospital mortality was 20%. Late death occurs 3 patients and the long-term morbidity was evaluated at 22%. A recurrence of anastomotic false aneurysm occurred in 4 patients (16%) (Range 7 months-1 year). In conclusion anastomotic false aneurysm is one of the major complications of vascular reconstruction; careful follow-up can detect the rare instances of anastomotic aneurysm and reoperation can be accomplished with a low-rate of adverse outcome.

[Small bowel obstruction secondary to massive hookworm infestation complicated by fatal plurimicrobial bacteriemia]. / Occlusion iléale par infestation massive par des ankylostomes responsable d'une septicémie plurimicrobienne d'évolution fatale.

INTRODUCTION: Intestinal symptoms (cramping, flatulence) and iron deficient anemia are classical presenting manifestations of duodenal hookworm infestation in patients living in endemic area. CASE REPORT: We report a 45-year-old immunocompetent metropolitan man who presented with intestinal obstruction secondary to massive hookworm infestation complicated by fatal plurimicrobial bacteriemia with refractory septic shock. CONCLUSION: We report a case of acute surgical abdominal presentation with septicemia and refractory shock syndrome due to ileal translocation secondary to massive hookworm infestation. To the best of our knowledge, such a case has not yet been reported.